Cost-effectiveness analysis of prevention strategies for gynecologic cancers in Lynch syndrome
Cost-effectiveness analysis of prevention strategies for gynecologic cancers in Lynch syndrome
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DOI：
10.1002/cncr.23554
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发表时间：
2008-07-15
期刊：
影响因子：
6.2
通讯作者：
Lu, Karen H.
中科院分区：
文献类型：
--
作者：
Kwon, Janice S.;Sun, Charlotte C.;Lu, Karen H.
背景。患有Lynch综合征（遗传性非息肉性结直肠癌）的女性患子宫内膜癌和卵巢癌的风险增加。筛查和预防性手术已被推荐为预防策略。在这项研究中，作者在马尔可夫决策分析模型中估计了这些策略的净健康效益和成本效益。在一个假设的Lynch综合征女性队列中比较了五种策略：1)不预防（“参考”）；2) 30岁预防性手术（子宫切除术和双侧输卵管-卵巢切除术）；3) 40岁预防性手术；4) 30岁起每年进行子宫内膜活检、阴道超声和ca125筛查；5)从30岁开始每年进行一次筛查，直到40岁进行预防性手术（联合策略）。净健康效益以质量调整生命年（QALYs）衡量，主要结局指标为增量成本-效果比（ICER）。基线和转移概率从已发表的文献中获得，成本来自美国卫生与公众服务部和卫生保健质量与研究局。对各参数的不确定度进行敏感性分析。联合策略提供了最高的净健康效益（18.98个QALY），但相对于次优策略（40岁时预防性手术），每个QALY的ICER为194,650美元。30岁预防性手术和每年筛查是替代策略。在40岁时进行年度筛查后进行预防性手术是最有效的妇科癌症预防策略，但与单独进行预防性手术相比，获益的增加需要付出巨大的代价。通过提高筛查的有效性和降低筛查成本，ICER将变得有利。
BACKGROUND. Women with Lynch syndrome (hereditary nonpolyposis colorectal cancer) have an increased lifetime risk for endometrial and ovarian cancer. Screening and prophylactic surgery have been recommended as prevention strategies. In this study, the authors estimated the net health benefits and cost-effectiveness of these strategies in a Markov decision-analytic model.METHODS. Five strategies were compared for a hypothetical cohort of women with Lynch syndrome: 1) no prevention ('reference'); 2) prophylactic surgery (hysterectomy and bilateral salpingo-oophorectomy) at age 30 years; 3) prophylactic surgery at age 40 years; 4) annual screening with endometrial biopsy, transvaginal ultrasound, and CA 125 from age 30 years; and 5) annual screening from age 30 years until prophylactic surgery at age 40 years (combined strategy). Net health benefit was measured in quality-adjusted life years (QALYs), and the primary outcome measured was the incremental cost-effectiveness ratio (ICER). Baseline and transition probabilities were obtained from published literature, and costs were from the U.S. Department of Health and Human Services and Agency for Health Care Quality and Research. Sensitivity analyses were performed for uncertainty around various parameters.RESULTS. The combined strategy provided the highest net health benefit (18.98 QALYs) but had an ICER of $194,650 per QALY relative to the next best strategy (prophylactic surgery at age 40 years). Prophylactic surgery at age 30 years and annual screening were dominated by alternate strategies.CONCLUSIONS. Annual screening followed by prophylactic surgery at age 40 years was the most effective gynecologic cancer prevention strategy, but the incremental benefit over prophylactic surgery alone was attained at substantial cost. The ICER would become favorable by improving the effectiveness and reducing the costs of screening in this population.