Systematic Review of Cost-Effectiveness Models in Prostate Cancer: Exploring New Developments in Testing and Diagnosis.
Systematic Review of Cost-Effectiveness Models in Prostate Cancer: Exploring New Developments in Testing and Diagnosis.
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DOI：
10.1016/j.jval.2021.07.002
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Sanghera S
中科院分区：
文献类型：
--
作者：
Keeney E;Thom H;Turner E;Martin RM;Morley J;Sanghera S
前列腺癌诊断的最新创新包括新的生物标记物和更准确的活检方法。这项研究评估了这些发展的成本效益的证据基础(例如，前列腺健康指数和磁共振成像[MRI]引导的活检)，并确定了未来成本效益模型的改进领域。2009年至2021年期间，使用国家卫生服务经济评估数据库、MEDLINE、Embase、卫生技术评估数据库、国家卫生与护理卓越研究所指南和联合王国国家筛查委员会指南进行了系统审查。从研究类型、模型输入、建模方法和成本-效果结论等方面提取相关数据，并对结果进行叙述性综合。总共纳入了22项基于模型的经济评估。共有11家公司将新的生物标志物的成本效益与单独进行前列腺特异性抗原检测进行了比较，所有人都发现生物标志物节省了成本。共有8种MRI引导的活检方法与经直肠超声引导的方法进行了比较，发现MRI引导的方法最具成本效益。新的检测方法显示，不必要的活检和过度治疗减少了。对于最初活检结果为阴性的男性，最具成本效益的随访策略尚不确定。许多研究没有对癌症的分期或分级、癌症进展或整个测试和治疗途径进行建模。几乎没有人完全解释了不确定性。这篇综述汇集了前列腺癌新诊断方法的成本效益文献，表明大多数研究发现新方法比标准治疗更具成本效益。然而，发现了这些模型的几个局限性，限制了结果的可靠性。进一步发展的领域包括准确模拟早期诊断测试对前列腺癌长期结果的影响，并充分考虑不确定性。
Recent innovations in prostate cancer diagnosis include new biomarkers and more accurate biopsy methods. This study assesses the evidence base on cost-effectiveness of these developments (eg, Prostate Health Index and magnetic resonance imaging [MRI]-guided biopsy) and identifies areas of improvement for future cost-effectiveness models. A systematic review using the National Health Service Economic Evaluation Database, MEDLINE, Embase, Health Technology Assessment databases, National Institute for Health and Care Excellence guidelines, and United Kingdom National Screening Committee guidance was performed, between 2009 and 2021. Relevant data were extracted on study type, model inputs, modeling methods and cost-effectiveness conclusions, and results narratively synthesized. A total of 22 model-based economic evaluations were included. A total of 11 compared the cost-effectiveness of new biomarkers to prostate-specific antigen testing alone and all found biomarkers to be cost saving. A total of 8 compared MRI-guided biopsy methods to transrectal ultrasound-guided methods and found MRI-guided methods to be most cost-effective. Newer detection methods showed a reduction in unnecessary biopsies and overtreatment. The most cost-effective follow-up strategy in men with a negative initial biopsy was uncertain. Many studies did not model for stage or grade of cancer, cancer progression, or the entire testing and treatment pathway. Few fully accounted for uncertainty. This review brings together the cost-effectiveness literature for novel diagnostic methods in prostate cancer, showing that most studies have found new methods to be more cost-effective than standard of care. Several limitations of the models were identified, however, limiting the reliability of the results. Areas for further development include accurately modeling the impact of early diagnostic tests on long-term outcomes of prostate cancer and fully accounting for uncertainty.
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