Economic Evaluation of Universal Lynch Syndrome Screening Protocols among Newly Diagnosed Patients with Colorectal Cancer.
Economic Evaluation of Universal Lynch Syndrome Screening Protocols among Newly Diagnosed Patients with Colorectal Cancer.
复制标题
新诊断结直肠癌患者中普遍Lynch综合征筛查方案的经济学评价。
DOI：
10.3390/jpm11121284
复制
发表时间：
2021-12-02
影响因子：
--
通讯作者：
Rahm AK
中科院分区：
文献类型：
--
作者：
Hao J;Hassen D;Gudgeon JM;Snyder SR;Hampel H;Williams MS;Sharaf RN;Lu CY;Williams JL;Schlieder V;Rahm AK
我们从医疗保健系统的角度进行了一项最新的经济评估，以比较8种林奇综合征(LS)筛查方案在新诊断的结直肠癌(CRC)患者中的相对有效性和效率。我们为1000名患者的假设队列开发了决策分析模型。模型假设和参数值基于文献和专家意见。所有成本均为2018美元。对于LS病例，直接生殖系测序(DGS)的灵敏度为99.90%(99.57~99.93%)，特异度为99.50%(97.28~99.85%)，其次是TSGS(灵敏度99.42%，96.55~99.63%；特异度96.58%，96.46~96.60%)。与微卫星不稳定(MSI)(22,988美元)、DGS(31,365美元)和TSGS(104,394美元)方案相比，免疫组织化学(IHC)方案最有效，每个LS病例20,082美元。在IHC和MSI方案中加入双体体试验没有改变敏感性和特异性，成本分别增加了6%和3.5%，但无法解释的病例分别减少了70%和50%。当生殖系测序的成本降至368美元以下时，DGS将与IHC协议一样有效，这表明DGS可能在不久的将来成为一种有效的选择。在此之前，IHC和MSI双体测试方案将是最佳选择。
We conducted an updated economic evaluation, from a healthcare system perspective, to compare the relative effectiveness and efficiency of eight Lynch syndrome (LS) screening protocols among newly diagnosed colorectal cancer (CRC) patients. We developed decision analytic models for a hypothetical cohort of 1000 patients. Model assumptions and parameter values were based on literature and expert opinion. All costs were in 2018 USD. For identifying LS cases, the direct germline sequencing (DGS) protocol provided the best performance (sensitivity 99.90%, 99.57–99.93%; specificity 99.50%, 97.28–99.85%), followed by the tumor sequencing to germline sequencing (TSGS) protocol (sensitivity, 99.42%, 96.55–99.63%; specificity, 96.58%, 96.46–96.60%). The immunohistochemistry (IHC) protocol was most efficient at $20,082 per LS case identified, compared to microsatellite instability (MSI) ($22,988), DGS ($31,365), and TSGS ($104,394) protocols. Adding double-somatic testing to IHC and MSI protocols did not change sensitivity and specificity, increased costs by 6% and 3.5%, respectively, but reduced unexplained cases by 70% and 50%, respectively. DGS would be as efficient as the IHC protocol when the cost of germline sequencing declines under $368 indicating DGS could be an efficient option in the near future. Until then, IHC and MSI protocols with double-somatic testing would be the optimal choices.
登录
查看更多内容
影响因子：
39.2
作者：
Ladabaum U;Wang G;Terdiman J;Blanco A;Kuppermann M;Boland CR;Ford J;Elkin E;Phillips KA
通讯作者：
Phillips KA
影响因子：
8.8
作者：
Deng, G;Peng, E;Gum, J;Terdiman, J;Sleisenger, M;Kim, Y S
通讯作者：
Kim, Y S
影响因子：
29.4
作者：
Haraldsdottir S;Hampel H;Tomsic J;Frankel WL;Pearlman R;de la Chapelle A;Pritchard CC
通讯作者：
Pritchard CC
影响因子：
2.2
作者：
Hampel, Heather;de la Chapelle, Albert
通讯作者：
de la Chapelle, Albert
影响因子：
7.3
作者：
Geurts-Giele, Willemina R. R.;Leenen, Celine H. M.;Dinjens, Winand N. M.
通讯作者：
Dinjens, Winand N. M.