加拿大基于人口的BRCA1和BRCA2测试的经济评估
Li Sun1,2, Xia Wei1,2, Caitlin T Fierheller2
1Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
JAMA network open
|September 12, 2024
概括
在加拿大,基于人口的BRCA检测比基于家族史的检测更具成本效益. 这种方法可以识别更多的BRCA携带者,从而有可能预防成千上万的乳腺和卵巢癌和死亡.
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:
- 目前的BRCA检测依赖于家族史 (FH),缺少许多携带者.
- 基于人群的BRCA测试提供了更广泛的风险个体的识别.
- 早期识别可以及时查和预防遗传性癌症的策略.
研究的目的:
- 在加拿大评估基于人口的BRCA测试与基于FH的测试的成本效益.
- 估计与每个测试策略相关的增量终身健康结果和成本.
- 为制定有关BRCA突变遗传查的政策决策提供信息.
主要方法:
- 一个马尔科夫模型被开发用于经济评估.
- 在加拿大妇女中,基于人口的BRCA测试与基于FH的BRCA测试的终身成本和结果的比较.
- 包括降低风险的干预措施,并从付款人和社会角度分析.
主要成果:
- 基于人口的BRCA测试产生了低于加拿大门的增量成本效益比率 (ICERs) (加拿大32276美元付款人;加拿大16416美元社会).
- 对于30-60岁的人来说,成本效益得到了观察,但不是70岁.
- 超过99%的模拟是具有成本效益的,有可能预防每百万女性2555例乳腺癌和485例卵巢癌.
结论:
- 与基于FH的测试相比,基于人口的BRCA测试在加拿大是一个具有成本效益的战略.
- 这种方法可以显著提高BRCA载体的检测.
- 转向以人口为基础的测试可以预防大量的乳腺和卵巢癌.
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