组织癌症查计划中多基因风险评分的益处和危害:成本效益分析
Changfa Xia1, Yongjie Xu1, He Li2
1Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
中国的多基因风险评分 (PRS) 分层癌症查提高了成本效益,并避免了比一般查更多的死亡. 降低PRS成本对于实施至关重要,使癌症查更有效.
科学领域:
- 遗传学和基因组学 遗传学和基因组学
- 公共卫生 公共卫生
- 卫生经济学 卫生经济学
背景情况:
- 多基因风险评分 (PRS) 显示了优化癌症查计划的潜力.
- 目前的PRS区分能力有限,需要进行成本效益分析.
- 这项研究评估了中国的PRS分层癌症查.
研究的目的:
- 进行PRS分层癌症查与非分层和没有查的成本效益分析.
- 评估PRS分层查的好处 (预防癌症死亡,获得QALY) 和危害 (过度诊断).
- 为了确定PRS分层选的增量成本效益比率 (ICER).
主要方法:
- 利用国家癌症中心 (NCC) 对六种主要癌症的建模框架.
- 模拟癌症发生率,进展,检测和死亡率.
- 60岁时进行一次性PRS分层查 (25%高风险),与非分层查和不进行查进行比较.
主要成果:
- PRS分层查避免了更多的癌症死亡 (61,237 vs 40,329),并且查所需的数量更少 (307 vs 451).
- 它产生了额外的130,045个QALY,额外成本为1.94亿美元,每次获得的QALY的ICER总额为14,930美元.
- 根据癌症类型,ICERs有所不同,从7928美元 (结肠直肠) 到39,068美元 (肝脏),并且对PRS成本和风险值敏感.
结论:
- PRS分层查适度提高了有组织的癌症查的临床益处和成本效益.
- 为了实现PRS的广泛实施,需要进一步降低多基因风险分层成本.
- 使用PRS进行有针对性的查为癌症控制提供了更有效的方法.
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