肺癌查用螺旋式计算机断层扫描在老年成人吸烟者:一个决定和成本效益分析
Parthiv J Mahadevia1, Lee A Fleisher, Kevin D Frick
1Robert Wood Johnson Clinical Scholars Program, Johns Hopkins School of Medicine, Baltimore, Md, USA. Mahadevia@medtap.com
JAMA
|January 15, 2003
概括
使用螺旋式CT的肺癌查显示了潜在的好处,但面临着重大的成本效益挑战. 由于不确定的好处和高成本,不建议直接向消费者营销.
科学领域:
- 肺部病理学 肺部病理学
- 放射学 放射学是一门学科.
- 卫生经济学 卫生经济学
背景情况:
- 直接向消费者销售促进螺旋计算断层扫描 (CT) 用于肺癌查.
- 螺旋CT是一种有希望但未经证实的成像程序,用于肺癌检测.
研究的目的:
- 估计使用螺旋CT的肺癌查的潜在益处,危害和成本效益.
- 在各种场景下评估查有效性.
主要方法:
- 一个计算机模拟模型将年度螺旋CT查与重度吸烟者 (目前吸烟者,戒烟者,前吸烟者) 没有查进行了比较.
- 通过从晚期到局部肺癌的"转变阶段"模拟的疗效.
- 嵌入偏见:领先时间,长度和过度诊断.
主要成果:
- 随着50%的阶段转变,目前的吸烟者患肺癌死亡人数减少了13%,但每10万例有1186例错误阳性侵入性手术.
- 目前吸烟者的增量成本效益为116,300美元/QALY,而前吸烟者的成本效益显著上升.
- 敏感性分析表明查成本效益不高,即使具有有利的参数,除非多个乐观的估计一致.
结论:
- 螺旋CT的肺癌查面临着成本效益的重大障碍,即使有效性已被证明.
- 目前关于侵入性测试的益处,危害和高成本的不确定性使得直接向消费者营销不宜.
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