对于疑似罕见遗传疾病的诊断途径中的外体序列测序:测试的顺序是否会影响其成本效益?
Koen Degeling1,2, Toni Tagimacruz2, Karen V MacDonald2
1Cancer Health Services Research, Centre for Health Policy and Centre for Cancer Research, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.
Applied health economics and health policy
|December 31, 2024
概括
作为一线诊断测试,外体序列 (ES) 显著提高罕见疾病诊断率并降低成本. 这种方法提供了最快的诊断时间,并且比在诊断途径中稍后使用更具成本效益.
科学领域:
- 遗传学 遗传学是一种遗传学.
- 医学诊断 医学诊断 医学诊断
- 卫生经济学 卫生经济学
背景情况:
- 怀疑患有罕见疾病的患者面临着长期和不确定的诊断旅程.
- 估计外基因组测序 (ES) 的成本效益对于优化罕见疾病诊断至关重要.
研究的目的:
- 在罕见遗传疾病 (RGD) 诊断途径的各个阶段评估外基因组测序 (ES) 的成本效益.
主要方法:
- 一个离散事件模拟模拟了使用305名接受临床级ES的患者回顾性数据的诊断途径.
- 五种策略进行了比较:没有ES,ES作为第1,第2,第3或第4次测试 (一至四级).
- 结果包括诊断产量,诊断的时间,途径持续时间和从加拿大医疗保健的角度来看的成本.
主要成果:
- 外体测序 (ES) 增加了16个百分点的诊断产量 (20%至36%).
- 第1级ES (第一次测试) 以最低的成本 (CAD2458) 实现了最高的诊断产量,诊断时间最短.
- 随着ES的后期实施,成本增加了:二级 (CAD3851),三级 (CAD5246) 和四级 (CAD6422).
结论:
- 作为一线诊断工具的外体序列 (ES) 显著提高了疑似罕见遗传疾病 (RGD) 的诊断产量.
- 在诊断途径的早期实施ES可以减少诊断的时间和整体测试成本.
- 尽管非ES测试的数据有限,但ES作为初级诊断策略具有相当大的价值.
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