Effectiveness and cost-effectiveness of prognostic markers in prostate cancer
Effectiveness and cost-effectiveness of prognostic markers in prostate cancer
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DOI：
10.1038/sj.bjc.6600630
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发表时间：
2003-01-13
影响因子：
8.8
通讯作者：
Paisley, S
中科院分区：
文献类型：
--
作者：
Calvert, NW;Morgan, AB;Paisley, S
本文展示了如何经济模型可以用来获得的成本效益的预后指标在临床上局部和中度分级前列腺癌的管理估计。该模型使用马尔可夫过程，并使用已发布的证据和本地数据进行填充。使用敏感性分析测试了结果的稳健性。三个治疗政策的“监测”（观察），根治性乳腺癌切除术，或选择为基础的管理政策，使用wDNA倍体作为实验标记，已进行了评估。模型表明，利用实验性标记物管理这些肿瘤的政策估计每质量调整生命年的成本为12 068英镑。敏感性分析表明，结果是相对敏感的生活质量变量。如果新的和实验性的标记物可以达到超过80%的特异性，那么对于那些被确定为高风险的患者进行根治性手术，对于其余患者进行保守治疗的政策将对患者更好，并且具有成本效益。分析表明，本文中模拟的中度分级肿瘤（Gleason分级5 - 7）的根治性直肠癌切除术治疗策略可能不如在缺乏可靠预后标志物的情况下的保守方法，成本更高且产生的QOLS更少。(C)2003年英国癌症研究。
This paper demonstrates how economic modelling can be used to derive estimates of the cost-effectiveness of prognostic markers in the management of clinically localised and moderately graded prostate cancer. The model uses a Markov process and is populated using published evidence and local data. The robustness of the results has been tested using sensitivity analysis. Three treatment policies of 'monitoring' (observation), radical prostatectomy, or a selection-based management policy using wDNA-ploidy as an experimental marker, have been evaluated. Modelling indicates that a policy of managing these tumours utilising experimental markers has an estimated cost per quality-adjusted life year (QALY) of pound12 068. Sensitivity analysis shows the results to be relatively sensitive to quality-of-life variables. If novel and experimental markers can achieve specificity in excess of 80%, then a policy of radical surgery for those identified as being at high risk and conservative treatment for the remainder would be both better for patients and cost-effective. The analysis suggests that a radical prostatectomy treatment policy for the moderately graded tumours (Gleason grades 5 - 7) modelled in this paper may be inferior to a conservative approach in the absence of reliable prognostic markers, being both more costly and yielding fewer QALYs. (C) 2003 Cancer Research UK.