Combined Biomarker and Computed Tomography Screening Strategies for Lung Cancer: Projections of Health and Economic Tradeoffs in the US Population.
Combined Biomarker and Computed Tomography Screening Strategies for Lung Cancer: Projections of Health and Economic Tradeoffs in the US Population.
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DOI：
10.1177/2381468316643968
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发表时间：
2016-07
影响因子：
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通讯作者：
Pandharipande P
中科院分区：
文献类型：
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作者：
Kong CY;Sheehan DF;McMahon PM;Gazelle GS;Pandharipande P
背景：对符合一定年龄和吸烟史标准的个体进行肺癌CT筛查是目前的标准治疗方法。方法：使用已发表的模拟模型，我们使用医疗保险和医疗补助服务中心的资格标准，比较了七种生物标志物+ CT筛查策略与单独CT筛查相关的结果。我们假设生物标志物具有条件独立的性能；用于部分或全部筛查个体的一线筛查；并且可以扩展到医疗保险和医疗补助服务中心——不合格的吸烟者。策略因纳入标准（如包年）和CT仍为一线检查的个体比例而异。每个模型都模拟了1950年出生的100万男性和100万女性。主要结局是癌症特异性死亡率降低和筛查费用；测量相对于CT的生物标志物成本。效率前沿确定了最佳的健康和经济权衡。敏感性分析评价结果的稳定性。结果：标准护理筛查在模拟的美国人群（筛查+未筛查个体）中产生了8.3%的癌症特异性死亡率降低。对于具有75%敏感性和95%特异性的生物标志物测试，生物标志物+ CT策略的死亡率降低幅度为7.0%至23.9%。如果生物标志物的成本是CT的0.86倍，则标准护理筛查仍然处于效率前沿，这表明相对于所有生物标志物+ CT策略，健康和经济权衡同样（或更）有效。生物标志物+ CT策略成本主要由生物标志物特异性驱动；死亡率的降低是由敏感性驱动的。结论：生物标志物+ CT联合策略有可能提高美国未来肺癌筛查的有效性，并实现高于当前标准治疗的经济效益。
Background: Lung cancer screening with computed tomography (CT) of individuals who meet certain age and smoking history criteria is the current standard-of-care. Methods: Using a published simulation model, we compared outcomes associated with seven biomarker + CT screening strategies to CT screening alone using Centers for Medicare & Medicaid Services eligibility criteria. We assumed that the biomarker had conditionally independent performance; was used for first-line screening in some, or all, individuals screened; and could be extended to Centers for Medicare & Medicaid Services–ineligible smokers. Strategies differed by inclusion criteria (e.g., pack-years) and proportion of individuals for whom CT remained the first-line test. Each model run simulated a combined cohort of one million men and one million women born in 1950. Primary outcomes were cancer-specific mortality reduction and screening costs; biomarker costs were measured relative to CT. Efficiency frontiers identified optimal health and economic tradeoffs. Sensitivity analysis evaluated the stability of results. Results: Standard-of-care screening yielded an 8.3% cancer-specific mortality reduction in the simulated US population (screened + unscreened individuals). For a biomarker test with 75% sensitivity and 95% specificity, mortality reductions across biomarker + CT strategies ranged from 7.0% to 23.9%. If the biomarker’s cost was >0.86× that of CT, standard-of-care screening remained on the efficiency frontier, indicating that health and economic tradeoffs were equally (or more) efficient relative to all biomarker + CT strategies. Biomarker + CT strategy costs were principally driven by biomarker specificity; mortality reduction was driven by sensitivity. Conclusion: Combined biomarker + CT strategies have the potential to improve future lung cancer screening effectiveness in the United States and achieve economic efficiency that is greater than the current standard-of-care.