Endoscopic Screening Program for Control of Esophageal Adenocarcinoma in Varied Populations: A Comparative Cost-Effectiveness Analysis.
Endoscopic Screening Program for Control of Esophageal Adenocarcinoma in Varied Populations: A Comparative Cost-Effectiveness Analysis.
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不同人群中食管腺癌控制的内镜筛查计划：一项比较成本效益分析。
DOI：
10.1053/j.gastro.2022.03.037
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发表时间：
2022-07
期刊：
影响因子：
29.4
通讯作者：
中科院分区：
文献类型：
--
作者：
指南建议对有胃食管反流病（GERD）症状和其他危险因素的个体进行内镜筛查食管腺癌（EAC）。我们的目的是确定在什么年龄进行筛查以及性别和种族是否会影响决定。我们使用 3 个独立的仿真模型进行了成本效益比较分析。对于每种性别和种族的组合（白人/黑人，各 100,000 人），我们考虑了 41 种筛查策略，包括一次性或重复筛查。最佳策略是具有最高有效性的策略，并且每个质量调整生命年的增量成本效益比<100,000 美元。在白人男性中，预计有 536 名 EAC 死亡者未经筛查，最好在 45 岁和 60 岁时对患有 GERD 的个体进行两次筛查。在 55 岁时对整个白人男性群体进行一次筛查是最佳的，概率敏感性分析运行率为 26%。未经筛查的黑人男性 EAC 死亡人数较少 (n = 84)，并且在 55 岁时对患有 GERD 的人进行一次筛查是最佳选择。尽管白人女性的 EAC 死亡人数 (n = 103) 略高于黑人男性，但最佳策略是不进行筛查，尽管在 29% 的概率敏感性分析中，在 55 岁时对患有 GERD 的患者进行一次筛查是最佳策略。黑人女性的 EAC 死亡负担非常低 (n = 29)，并且没有哪种筛查是最佳的，因为益处非常小，而且一些策略造成了净伤害。最佳筛查策略因种族和性别而异。患有胃食管反流病症状的白人男性可能会接受比目前建议更严格的筛查。对女性进行筛查不具有成本效益，并且可能对黑人女性造成净伤害。
Guidelines suggest endoscopic screening for esophageal adenocarcinoma (EAC) among individuals with symptoms of gastroesophageal reflux disease (GERD) and additional risk factors. We aimed to determine at what age to perform screening and whether sex and race should influence the decision. We conducted comparative cost-effectiveness analyses using 3 independent simulation models. For each combination of sex and race (White/Black, 100,000 individuals each), we considered 41 screening strategies, including one-time or repeated screening. The optimal strategy was that with the highest effectiveness and an incremental cost-effectiveness ratio <$100,000 per quality-adjusted life-year gained. Among White men, 536 EAC deaths were projected without screening, and screening individuals with GERD twice at ages 45 and 60 years was optimal. Screening the entire White male population once at age 55 years was optimal in 26% of probabilistic sensitivity analysis runs. Black men had fewer EAC deaths without screening (n = 84), and screening those with GERD once at age 55 years was optimal. Although White women had slightly more EAC deaths (n = 103) than Black men, the optimal strategy was no screening, although screening those with GERD once at age 55 years was optimal in 29% of probabilistic sensitivity analysis runs. Black women had a very low burden of EAC deaths (n = 29), and no screening was optimal, as benefits were very small and some strategies caused net harm. The optimal strategy for screening differs by race and sex. White men with GERD symptoms can potentially be screened more intensely than is recommended currently. Screening women is not cost-effective and may cause net harm for Black women.
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