关于返回未解释疑似遗传条件的基因组测序的二次发现的前性,观察性成本效益分析的协议
Wendy J Ungar1, Robin Z Hayeems1, Christian R Marshall2
1Program in Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Clinical therapeutics
|July 15, 2023
概括
全基因组测序 (GWS) 的二次发现可以确定未来的健康风险. 这项研究评估了在患有遗传疾病的儿童中进行GWS二次发现测试的成本效益.
科学领域:
- 基因组医学是基因组医学.
- 卫生经济学 卫生经济学
- 临床遗传学 临床遗传学
背景情况:
- 全基因组测序 (GWS) 为诊断和评估疾病风险提供了全面的变异检测.
- GWS可以识别像BRCA1/BRCA2这样的基因中的二次发现,促使早期干预,但引起了对成本和临床实用性的担忧.
- 越来越多的二次发现需要评估它们在医疗保健中的经济影响和有效性.
研究的目的:
- 确定临床GWS中对患有不明原因遗传疾病的儿童进行二次发现确认的增量成本效益.
- 评估每例检测的成本效益和每单位改善的临床效用.
- 根据临床实践和资助决策,为二次发现测试提供信息.
主要方法:
- 符合条件的参与者接受三基因组或外基因组测序.
- 根据年龄,初级结果和指示,将阳性二次发现指数病例与负控件 (1:2) 相匹配.
- 在两年内从患者和一名成年家庭成员那里收集卫生服务使用数据.
- 从公共和社会付款人的角度进行成本估计.
- 第二次发现 - - 阳性和负性组之间的平均成本的统计比较.
- 使用临床管理变化或临床医生报告的遗传检测实用性指数 (C-GUIDE) 来计算增量成本效益比率 (ICER) 和估计有效性.
主要成果:
- 该研究预计将在两年内提供71例病例和142个匹配的对照组的数据.
- 分析将在具有和没有积极的二次发现的组之间比较成本和临床效用.
- 敏感性分析将评估发现对关键参数变化的稳定性.
结论:
- 这项研究为临床实践和资源配置提供了关键的证据,涉及GWS的次要发现.
- 这项研究通过包括家庭成员和采用临床实用性的新方法来推进基因组学中的经济评估.
- 结果将指导医疗保健提供者和决策者管理二次遗传发现的影响.
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