Comparative effectiveness of screening and prevention strategies among BRCA1/2-affected mutation carriers.
Comparative effectiveness of screening and prevention strategies among BRCA1/2-affected mutation carriers.
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DOI：
10.1007/s10549-010-1043-4
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发表时间：
2011-02
影响因子：
3.8
通讯作者：
Neugut, Alfred I.
中科院分区：
文献类型：
--
作者：
Grann, Victor R.;Patel, Priya R.;Jacobson, Judith S.;Warner, Ellen;Heitjan, Daniel F.;Ashby-Thompson, Maxine;Hershman, Dawn L.;Neugut, Alfred I.
关键词：
在大多数发达国家，比较有效性研究已成为卫生保健规划的一个组成部分。在一组年龄在30-65岁之间，BRCA 1或BRCA 2突变检测呈阳性的女性模拟队列中，我们比较了乳腺X线摄影加和不加MRI、预防性卵巢切除加和不加乳房切除术、单纯乳房切除术和化学预防的结果。方法：使用Treatment9.02软件，我们开发了马尔可夫模型，25,000 Monte Carlo模拟，并进行了概率敏感性分析。我们基于突变率，乳腺癌和卵巢癌的发病率，死亡率，以及2009年美元的成本，来自监测，流行病学和最终结果（SEER）计划和医疗保险和医疗补助服务中心的已发表研究和数据。我们使用从突变携带者和对照组中获得的偏好评级来调整生存质量（QOLS）。结果如下：对于BRCA 1突变携带者，预防性卵巢切除术每QALY 1，741美元，比两种手术更具成本效益，并主导了所有其他干预措施。对于BRCA 2携带者，预防性卵巢切除术，每QALY 4，587美元，比两种手术更具成本效益。如果不进行质量调整，乳房切除术和BSO手术在所有其他干预措施中占主导地位。在所有模拟中，预防性手术或化学预防占主导地位，或比筛查更具成本效益，因为筛查方式昂贵。结论：我们的分析表明，在BRCA 1/2突变携带者中，与化学预防和筛查相比，预防性手术将占主导地位或具有成本效益。每年进行一次MRI和乳房X光检查是最有效的策略，因为它与最长的质量调整生存期相关，但它也非常昂贵。
Comparative effectiveness research has become an integral part of health care planning in most developed countries. In a simulated cohort of women, aged 30–65, who tested positive for BRCA1 or BRCA2 mutations, we compared outcomes of mammography with and without MRI, prophylactic oophorectomy with and without mastectomy, mastectomy alone, and chemoprevention. Methods: Using Treeage 9.02 software, we developed Markov models with 25,000 Monte Carlo simulations and conducted probabilistic sensitivity analysis. We based mutation penetrance rates, breast and ovarian cancer incidence, and mortality rates, and costs in terms of 2009 dollars, on published studies and data from the Surveillance, Epidemiology, and End Results (SEER) Program and the Centers for Medicare and Medicaid Services. We used preference ratings obtained from mutation carriers and controls to adjust survival for quality of life (QALYs). Results: For BRCA1 mutation carriers, prophylactic oophorectomy at $1,741 per QALY, was more cost effective than both surgeries and dominated all other interventions. For BRCA2 carriers, prophylactic oophorectomy, at $4,587 per QALY, was more cost effective than both surgeries. Without quality adjustment, both mastectomy and BSO surgeries dominated all other interventions. In all simulations, preventive surgeries or chemoprevention dominated or were more cost effective than screening because screening modalities were costly. Conclusion: Our analysis suggested that among BRCA1/2 mutation carriers, prophylactic surgery would dominate or be cost effective compared to chemoprevention and screening. Annual screening with MRI and mammography was the most effective strategy because it was associated with the longest quality-adjusted survival, but it was also very expensive.
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