对肺癌中等风险患者的计算机断层查间隔
Koen de Nijs1, Harry J de Koning1, Pianpian Cao2
1Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.
适应性肺癌查间隔,从年轻人和有较少吸烟史的人每两年进行查开始,保留了大多数益处,同时减少了计算机断层扫描 (CT) 扫描. 这种方法比高风险人群的年度查更具成本效益.
科学领域:
- 卫生经济学和结果研究研究.
- 胸部瘤学 胸部瘤学
- 预防医学 预防医学
背景情况:
- 美国预防服务工作组 (USPSTF) 建议每年对50-80岁高风险人群进行肺癌计算机断层扫描 (CT) 查.
- 国际指导方针各不相同,有些建议每两年进行一次查,以减轻频繁查的负担.
- 根据年龄,性别和吸烟史等个体风险因素量身定制的适应性查间隔对肺癌查益处的影响尚不清楚.
研究的目的:
- 与年度查相比,评估与适应性肺癌查间隔相关的健康结果和经济成本.
- 确定个性化查策略的成本效益.
主要方法:
- 使用两种癌症干预和监测建模网络 (CISNET) 模型和OncoSim模型进行比较经济建模.
- 模拟美国1965年出生队列,接受肺癌查,根据年龄,性别和吸烟史 (10-30+包年) 进行适应间隔.
- 评估结果,包括预防肺癌死亡,增加寿命,CT屏幕数量和成本,使用100,000美元/QALY的支付意愿门.
主要成果:
- 从50岁到60岁进行两年一次查,然后再进行一年一次查的策略,可预防95.9%的肺癌死亡,同时与年一次查相比,CT扫描减少20.6%.
- 对于所有符合条件的个人 (50-80岁) 的年度查在假设的支付意愿门上是不具有成本效益的.
- 具有成本效益的适应策略因风险组而异,但通常涉及每两年开始查,并在60岁或达到30-40包年时过渡到年度查.
结论:
- 对于60岁以下和30包年不到的吸烟者,每两年进行肺癌查,与年度查相比,有效地保持了查的好处.
- 适应性查间隔对于肺癌查计划,尤其是那些面临预算限制的项目,是一种潜在的更有效的资源利用方法.
- 根据个体风险因素量身定制的个性化查策略可以优化肺癌检测好处和查负担之间的平衡.
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