结直肠癌查的新型非侵入性测试 - - 一个成本效益分析
Mingjun Rui1, Yingcheng Wang1, Joyce Hs You2
1The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, Hong Kong.
概括
多目标便RNA (mt-sRNA) 测试是结直肠癌 (CRC) 查的成本效益较高的选择,尤其是在不完全遵守查指南的情况下. 这种新型的非侵入性测试在现实世界中为传统方法提供了可行的替代方案.
科学领域:
- 卫生经济学 卫生经济学
- 胃肠病学 胃肠病学
- 预防医学 预防医学
背景情况:
- 结肠直肠癌 (CRC) 查对于早期检测和预防至关重要.
- 新的非侵入性测试为当前指南推的查方法提供了潜在的替代方案.
- 从付款人的角度评估这些新测试的成本效益至关重要.
研究的目的:
- 为了比较三个新型非侵入性CRC查测试的成本效益:多目标便RNA (mt-sRNA),多目标便DNA2.0 (mt-sDNA2.0) 和无细胞DNA (cf-DNA).
- 将这些新型测试与指南推的现有CRC查策略进行比较.
- 从美国的付款人的角度分析查结果.
主要方法:
- 一个终身的马尔科夫模型模拟了45岁的10万个平均CRC风险的假设群体的结果.
- 查策略包括结肠镜检查,柔性半导体检查,CT结肠镜检查,FIT检查,HS-gFOBT检查,多目标便DNA检查,三种新型的非侵入性检查和不进行查.
- 进行了完全遵守 (100%) 和测试特定 (现实世界) 遵守的场景分析,测量了直接成本,QALY和ICER.
主要成果:
- 所有测试的查策略都比不进行查更具成本效益.
- 在完美遵守的情况下,年度结肠镜检查是首选的策略 (ICER=$261/QALY).
- 在现实世界中,每3年一次的mt-sRNA查是最具成本效益的策略 (ICER=95,250美元/QALY),在100,000美元/QALY的支付意愿下,显示成本效益的可能性最高.
结论:
- 所有评估的结直肠癌查策略都显示出与不进行查相比的成本效益.
- 每三年一次的mt-sRNA测试在反映现实世界的坚持的情况下,成为首选的成本效益战略.
- mt-sRNA为CRC查提供了一种有价值,具有成本效益的替代方案,特别是在临床实践中完全遵守查或随访是具有挑战性的情况下.
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