查BRCA1/2突变载体的成本效益与乳腺磁共振成像
Sylvia K Plevritis1, Allison W Kurian, Bronislava M Sigal
1Department of Radiology, Division of Oncology, Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, Calif 94305, USA. sylvia.plevritis@stanford.edu
JAMA
|May 25, 2006
概括
将乳房MRI查添加到乳房扫描中,对于BRCA1突变携带者来说,比BRCA2携带者更具成本效益. 进行MRI查的最佳年龄因BRCA突变状态而异.
科学领域:
- 在瘤学瘤学.
- 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:
- 具有遗传BRCA1/2突变的女性面临高乳腺癌风险.
- 乳房扫描通常无法检测这些高风险个体的早期癌症.
- 与对比度增强的乳房MRI提供更早的检测,但增加了成本和错误阳性.
研究的目的:
- 评估查BRCA1/2突变载体的成本效益,使用乳房扫描加乳房MRI与单独使用乳房扫描相比.
- 确定将MRI纳入高风险妇女现有查方案的经济价值.
主要方法:
- 一个计算机模拟模型在不同的查场景下评估了BRCA1/2突变载体的生命史.
- 高风险女性的乳房扫描和MRI准确度数据来源于已发表的文献.
- 乳腺癌存活率数据和医疗保健费用 (2005年医疗保险支付) 被纳入.
主要成果:
- 每年进行乳房镜检查和核磁共振成像 (MRI) 检查的每年质量调整生命年 (QALY) 的成本从45,000美元增加到超过700,000美元.
- 从35-54岁增加MRI查的成本为BRCA1携带者的55,420美元/QALY和BRCA2携带者的130,695美元/QALY.
- 对于具有密集乳房的BRCA2携带者,当添加MRI时,成本为98,454美元/QALY.
结论:
- 与BRCA2突变携带者相比,乳腺MRI查对BRCA1突变携带者来说更具成本效益.
- 开始和结束MRI查的年龄范围显著影响其成本效益.
- 乳房扫描加MRI代表了一个有价值的,虽然取决于年龄,对BRCA突变载体的查策略.
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