Stool DNA testing to screen for colorectal cancer in the Medicare population: a cost-effectiveness analysis.
Stool DNA testing to screen for colorectal cancer in the Medicare population: a cost-effectiveness analysis.
复制标题
DOI：
10.7326/0003-4819-153-6-201009210-00004
复制
发表时间：
2010-09-21
影响因子：
39.2
通讯作者：
van Ballegooijen M
中科院分区：
文献类型：
--
作者：
Lansdorp-Vogelaar I;Kuntz KM;Knudsen AB;Wilschut JA;Zauber AG;van Ballegooijen M
医疗保险和医疗补助服务中心(CMS)考虑是否报销联邦医疗保险参与者结直肠癌筛查的粪便DNA测试。评估粪便DNA检测与目前由CMS报销的结直肠癌筛查检测相比具有成本效益的条件。使用两个自主开发的模型进行比较微观仿真建模研究。源自文学。65岁(符合联邦医疗保险)的个人；50岁的个人作为敏感度分析。终身监禁。第三方付款人。与目前推荐的结直肠癌筛查策略相比，每3或5年进行一次粪便DNA检测。预期寿命、寿命成本、增量成本效益比、门槛成本。假设每次检测的成本为350美元，每隔3年或5年进行一次粪便DNA检测的策略比目前推荐的结直肠癌筛查策略产生的寿命更短，成本更高。使用粪便DNA检测进行筛查将具有成本效益，根据所使用的模拟模型，三年一次的粪便DNA检测每次检测费用为40至60美元。在目前每次检测350美元的情况下，粪便DNA检测不存在成本效益高的敏感性和特异性水平。如果粪便DNA检测的相对依从性比其他筛查测试至少好50%，则每隔3年进行一次粪便DNA检测将具有成本效益，每次检测的成本为350美元。当考虑50岁的队列时，上述结果都没有显著变化。我们没有对传统的腺瘤-癌序列以外的其他途径进行建模。只有当检测成本大幅降低，或者如果检测的可用性能够吸引很大一部分原本未进行筛查的人进行筛查，粪便DNA检测才能成为结直肠癌筛查的经济有效的替代方案。医疗保健研究和质量局
Centers for Medicare and Medicaid Services (CMS) considered whether to reimburse stool DNA testing for colorectal cancer screening among Medicare enrollees. To evaluate the conditions under which stool DNA testing could be cost-effective compared with the colorectal cancer screening tests currently reimbursed by CMS. Comparative microsimulation modeling study using two independently-developed models. Derived from literature. 65-year-old (Medicare eligible) individuals; 50-year old individuals as sensitivity analysis. Lifetime. Third-party payer. Stool DNA test every 3 or 5 years in comparison to currently-recommended colorectal cancer screening strategies. Life expectancy, lifetime costs, incremental cost-effectiveness ratios, threshold costs. Assuming a cost of $350 per test, strategies of stool DNA testing every 3 or 5 years yielded fewer life-years and higher costs than the currently recommended colorectal cancer screening strategies. Screening with the stool DNA test would be cost-effective at per-test cost of $40 to $60 for 3-yearly stool DNA testing, depending on the simulation model used. There were no levels of sensitivity and specificity for which stool DNA testing would be cost-effective at its current cost of $350 per test. Stool DNA testing at 3-yearly intervals would be cost-effective at a cost of $350 per test if the relative adherence with stool DNA testing were at least 50% better than with other screening tests. None of the above mentioned results changed significantly when considering a 50-year old cohort. We did not model other pathways than the traditional adenoma-carcinoma sequence. Only if a significant reduction can be made to the test cost or if its availability would entice a large fraction of otherwise unscreened persons to be screened will stool DNA testing be a cost-effective alternative for colorectal cancer screening. Agency for Healthcare Research and Quality
登录
查看更多内容
影响因子：
39.2
作者：
Ahlquist DA;Sargent DJ;Loprinzi CL;Levin TR;Rex DK;Ahnen DJ;Knigge K;Lance MP;Burgart LJ;Hamilton SR;Allison JE;Lawson MJ;Devens ME;Harrington JJ;Hillman SL
通讯作者：
Hillman SL
影响因子：
10.3
作者：
Allison, James E.;Sakoda, Lori C.;Selby, Joseph V.
通讯作者：
Selby, Joseph V.
影响因子：
3.9
作者：
ARMINSKI, T. C.;McLEAN, D. W.
通讯作者：
McLEAN, D. W.
影响因子：
24.5
作者：
JASS, JR;YOUNG, PJ;ROBINSON, EM
通讯作者：
ROBINSON, EM
影响因子：
1.9
作者：
JOHANNSEN, LGK;MOMSEN, O;JACOBSEN, NO
通讯作者：
JACOBSEN, NO