Cost-Effectiveness of Liquid Biopsy for Colorectal Cancer Screening in Patients Who Are Unscreened.
Cost-Effectiveness of Liquid Biopsy for Colorectal Cancer Screening in Patients Who Are Unscreened.
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DOI：
10.1001/jamanetworkopen.2023.43392
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发表时间：
2023-11-01
影响因子：
13.8
通讯作者：
Hur, Chin
中科院分区：
文献类型：
--
作者：
Aziz, Zainab;Wagner, Sophie;Agyekum, Alice;Pumpalova, Yoanna S.;Prest, Matthew;Lim, Francesca;Rustgi, Sheila;Kastrinos, Fay;Grady, William M.;Hur, Chin
液体活检检测是一种具有成本效益的结直肠癌筛查方法吗，特别是对于那些拒绝传统筛查方法的患者？在这项经济评估中，模拟了一组年龄在45岁、平均患结直肠癌风险的患者，结肠镜检查是首选的（最具成本效益的）筛查方法，每生命年获得的增量成本效益比为28071美元。为拒绝结肠镜检查的患者提供液体活检检查可获得最大的生命年收益，但成本效益不高。这些发现表明，在拒绝传统的结直肠癌筛查的患者中，液体活检作为一种替代筛查方法并不具有成本效益。本经济评估评估了液体活检在美国结肠直肠筛查的成本效益。尽管建议进行普遍筛查，但在美国坚持进行结直肠癌筛查的比例约为60%。用于癌症早期检测的液体活检测试正在开发中，但尚不清楚它们是否具有结肠直肠癌筛查的成本效益。评估液体活检在美国结肠直肠癌筛查中的成本效益。在这项经济评估中，建立了一个马尔可夫模型来比较无筛查和5种结直肠癌筛查策略：结肠镜检查、液体活检、结肠镜检查不符合后的液体活检、粪便DNA和粪便免疫化学测试。假设结肠镜、粪便DNA或粪便免疫化学测试的一线筛查依从性为60.6%，液体活检的依从性为100%。对于结肠镜检查、粪便DNA和粪便免疫化学测试，未坚持测试的患者不进行其他筛查。在结肠镜-液体活检混合中，液体活检是延迟结肠镜检查的二线筛查。进行情景分析，包括液体活检检测息肉的可能性。无筛查，结肠镜检查，粪便免疫化学测试，粪便DNA，液体活检，结肠镜-液体活检混合筛查。模型结果包括预期寿命、总成本和增量成本-效果比。如果一项战略的增量成本效益比低于美国的支付意愿阈值，即每增加一个生命年10万美元，则该战略被认为具有成本效益。这项研究使用了一组年龄在45岁、患结直肠癌平均风险的模拟队列患者。在基本情况下，结肠镜检查是首选的或具有成本效益的策略，每个生命年增加的成本效益比为28071美元。结肠镜-液体活检混合疗法的寿命年增幅最大，但成本-效果比增量为377538美元。如果液体活检可以检测到息肉，但仍然过于昂贵，结肠镜检查-液体活检混合有更大的寿命年增长。在对液体活检用于结直肠癌筛查的经济评估中，结肠镜检查在一般人群中是一种具有成本效益的结直肠癌筛查策略，而将液体活检作为一线或二线筛查策略，以其目前的成本和筛查效果来看，并不具有成本效益。如果成本大幅降低，用于结直肠癌筛查的液体活检检查可能具有成本效益。
Is liquid biopsy testing a cost-effective method for colorectal cancer screening, particularly in patients who refuse traditional screening methods? In this economic evaluation using a simulated cohort of patients aged 45 years with average risk of colorectal cancer, colonoscopy was the preferred (most cost-effective) screening method, with an incremental cost-effectiveness ratio of $28 071 per life-year gained. Offering liquid biopsy testing to patients who refused colonoscopy resulted in the greatest gain of life-years but was not cost-effective. These findings suggest that in patients who refuse traditional screening for colorectal cancer, liquid biopsy is not cost-effective as an alternative screening method. This economic evaluation estimates the cost-effectiveness of liquid biopsy for colorectal screening in the US. Despite recommendations for universal screening, adherence to colorectal cancer screening in the US is approximately 60%. Liquid biopsy tests are in development for cancer early detection, but it is unclear whether they are cost-effective for colorectal cancer screening. To estimate the cost-effectiveness of liquid biopsy for colorectal cancer screening in the US. In this economic evaluation, a Markov model was developed to compare no screening and 5 colorectal cancer screening strategies: colonoscopy, liquid biopsy, liquid biopsy following nonadherence to colonoscopy, stool DNA, and fecal immunochemical test. Adherence to first-line screening with colonoscopy, stool DNA, or fecal immunochemical test was assumed to be 60.6%, and adherence for liquid biopsy was assumed to be 100%. For colonoscopy, stool DNA, and fecal immunochemical test, patients who did not adhere to testing were not offered other screening. In colonoscopy–liquid biopsy hybrid, liquid biopsy was second-line screening for those who deferred colonoscopy. Scenario analyses were performed to include the possibility of polyp detection for liquid biopsy. No screening, colonoscopy, fecal immunochemical test, stool DNA, liquid biopsy, and colonoscopy–liquid biopsy hybrid screening. Model outcomes included life expectancy, total cost, and incremental cost-effectiveness ratios. A strategy was considered cost-effective if it had an incremental cost-effectiveness ratio less than the US willingness-to-pay threshold of $100 000 per life-year gained. This study used a simulated cohort of patients aged 45 years with average risk of colorectal cancer. In the base case, colonoscopy was the preferred, or cost-effective, strategy with an incremental cost-effectiveness ratio of $28 071 per life-year gained. Colonoscopy–liquid biopsy hybrid had the greatest gain in life-years gained but had an incremental cost-effectiveness ratio of $377 538. Colonoscopy–liquid biopsy hybrid had a greater gain in life-years if liquid biopsy could detect polyps but remained too costly. In this economic evaluation of liquid biopsy for colorectal cancer screening, colonoscopy was a cost-effective strategy for colorectal cancer screening in the general population, and the inclusion of liquid biopsy as a first- or second-line screening strategy was not cost-effective at its current cost and screening performance. Liquid biopsy tests for colorectal cancer screening may become cost-effective if their cost is substantially lowered.
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影响因子：
39.2
作者：
García-Albéniz X;Hsu J;Bretthauer M;Hernán MA
通讯作者：
Hernán MA
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3.8
作者：
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影响因子：
2.1
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1.9
作者：
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通讯作者：
Ford, Marvella E.
影响因子：
2.1
作者：
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通讯作者：
O'Hagan, T