Cost-Effectiveness Analysis of Screening for KRAS and BRAF Mutations in Metastatic Colorectal Cancer
Cost-Effectiveness Analysis of Screening for KRAS and BRAF Mutations in Metastatic Colorectal Cancer
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DOI：
10.1093/jnci/djs433
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发表时间：
2012-12-01
影响因子：
10.3
通讯作者：
Maciosek, Michael V.
中科院分区：
文献类型：
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作者：
Behl, Ajay S.;Goddard, Katrina A. B.;Maciosek, Michael V.
背景2009年，美国临床肿瘤学会建议，转移性结直肠癌（mCRC）患者谁是抗表皮生长因子受体（EGFR）治疗的候选人，他们的肿瘤进行KRAS突变检测，因为这种突变的肿瘤不响应抗EGFR治疗。将抗EGFR治疗限制在没有KRAS突变的患者中，将为那些可能受益的患者保留治疗，同时避免不必要的费用和对那些不会受益的患者的伤害。类似地，具有BRAF基因突变的肿瘤可能对抗EGFR治疗没有反应，尽管这不太清楚。突变检测的经济分析还没有充分探讨替代疗法和切除metabolis.Methods本文的作用是基于一个决策分析框架，形成了成本效益分析的基础上筛选KRAS和BRAF突变的背景下，与西妥昔单抗治疗的mCRC。对50000例mCRC患者的队列进行了10000次模拟，根据随机对照试验的分布随机分配属性。（无抗EGFR治疗）将预期总生存期延长0.034年，成本为22033美元，寿命每延长一年，成本效益递增率约为65万美元。与不进行筛查的抗EGFR治疗相比，增加KRAS检测可为每位患者节省约7500美元;增加BRAF检测可再节省1023美元，预期生存率几乎没有降低。结论筛查KRAS和BFAF突变可提高抗EGFR治疗的成本效益，但增量成本效益比仍高于可接受成本效益比的普遍接受门槛值100 000美元/质量调整生命年J Natl Cancer Inst 2012;104：1785-1795
Background In 2009, the American Society of Clinical Oncology recommended that patients with metastatic colorectal cancer (mCRC) who are candidates for anti-epidermal growth factor receptor (EGFR) therapy have their tumors tested for KRAS mutations because tumors with such mutations do not respond to anti-EGFR therapy. Limiting anti-EGFR therapy to those without KRAS mutations will reserve treatment for those likely to benefit while avoiding unnecessary costs and harm to those who would not. Similarly, tumors with BRAF genetic mutations may not respond to anti-EGFR therapy, though this is less clear. Economic analyses of mutation testing have not fully explored the roles of alternative therapies and resection of metastases.Methods This paper is based on a decision analytic framework that forms the basis of a cost-effectiveness analysis of screening for KRAS and BRAF mutations in mCRC in the context of treatment with cetuximab. A cohort of 50 000 patients with mCRC is simulated 10 000 times, with attributes randomly assigned on the basis of distributions from randomized controlled trials.Results Screening for both KRAS and BRAF mutations compared with the base strategy (of no anti-EGFR therapy) increases expected overall survival by 0.034 years at a cost of $22 033, yielding an incremental cost-effectiveness ratio of approximately $650 000 per additional year of life. Compared with anti-EGFR therapy without screening, adding KRAS testing saves approximately $7500 per patient; adding BRAF testing saves another $1023, with little reduction in expected survival.Conclusions Screening for KRAS and BFAF mutation improves the cost-effectiveness of anti-EGFR therapy, but the incremental cost effectiveness ratio remains above the generally accepted threshold for acceptable cost effectiveness ratio of $100 000/quality adjusted life year. J Natl Cancer Inst 2012;104:1785-1795