Routine echocardiography screening for asymptomatic left ventricular dysfunction in childhood cancer survivors: a model-based estimation of the clinical and economic effects.
Routine echocardiography screening for asymptomatic left ventricular dysfunction in childhood cancer survivors: a model-based estimation of the clinical and economic effects.
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DOI：
10.7326/m13-2266
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发表时间：
2014-05-20
影响因子：
39.2
通讯作者：
Diller L
中科院分区：
文献类型：
--
作者：
Yeh JM;Nohria A;Diller L
接受心脏毒性治疗的儿童癌症幸存者建议每1至5年进行常规心脏评估，但长期益处尚不确定。评估常规心脏评估检测无症状左心室功能障碍（ALVD）和血管紧张素转换酶抑制剂（ACEI）和β -肾上腺素能阻断（BB）治疗减少儿童癌症幸存者充血性心力衰竭（CHF）的成本-效果。仿真模型。文献，包括儿童癌症幸存者研究数据。儿童癌症幸存者一生。社会。每隔1年、2年、5年或10年进行一次基于间隔的超声心动图评估，随后进行ACEI/BB治疗以获得阳性结果。终生收缩期CHF风险、终生成本、质量调整预期寿命、增量成本-效果比（ICERs）。在没有常规心脏评估的情况下，15- 5岁儿童癌症幸存者的终生CHF风险为18.8%（平均发病年龄为58.8岁）。常规超声心动图将终生CHF风险降低2.3%（每10年评估一次）至8.7%（每年评估一次）。与不评估相比，每10年评估的ICER为111,600美元/QALY。每5年评估一次的风险风险评估为117,900美元/QALY，而更频繁评估的风险风险评估超过165,000美元/QALY。对于暴露于总蒽环类药物≥250 mg/m2的个体，每2年评估的ICER为83,600美元/QALY。结果对治疗效果、绝对超额CHF风险和ALVD无症状期敏感。对于整个队列，每10年或5年评估一次的概率为0.33美元/QALY阈值。基于成人数据的治疗效果。目前心脏评估的建议可能会降低CHF的发病率，但更少的评估可能是可取的。国家癌症研究所。
Childhood cancer survivors treated with cardiotoxic therapies are recommended to undergo routine cardiac assessment every 1 to 5 years, yet the long-term benefits are uncertain. To estimate the cost-effectiveness of routine cardiac assessment to detect asymptomatic left-ventricular dysfunction (ALVD) and angiotensin-converting enzyme inhibitor (ACEI) and beta-adrenergic blocking (BB) treatment to reduce congestive heart failure (CHF) in childhood cancer survivors. Simulation model. Literature, including Childhood Cancer Survivor Study data. Childhood cancer survivors Lifetime. Societal. Interval-based echocardiography assessment every 1, 2, 5 or 10 years, with subsequent ACEI/BB treatment for positive results. Lifetime systolic CHF risk, lifetime costs, quality-adjusted life expectancy, incremental cost-effectiveness ratios (ICERs). The lifetime CHF risk among 15-year-old 5-year childhood cancer survivors was 18.8% without routine cardiac assessment (average onset age 58.8 years). Routine echocardiography reduced lifetime CHF risk by 2.3% (with assessment every 10 years) to 8.7% (annual assessment). Compared to no assessment, the ICER for assessment every 10 years was $111,600/QALY. Assessment every 5 years had an ICER of $117,900/QALY, and the ICER for more frequent assessment exceeded >$165,000/QALY. For individuals exposed to ≥250 mg/m2 total anthracycline, the ICER for assessment every 2 years was $83,600/QALY. Results were sensitive to treatment effectiveness, absolute excess CHF risk, and ALVD asymptomatic period. For the overall cohort, the probability that assessment every 10 or 5 years was preferred at a $100,000/QALY threshold was 0.33. Treatment effectiveness based on adult data. Current recommendations for cardiac assessment may reduce CHF incidence, but less frequent assessment may be preferable. National Cancer Institute.