Ramsey S D, Clarke L, Etzioni R, Higashi M, Berry K, Urban N
Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North (MP-900), Box 19024, Seattle, WA 98109, USA.
Ann Intern Med. 2001 Oct 16;135(8 Pt 1):577-88. doi: 10.7326/0003-4819-135-8_part_1-200110160-00008.
The National Cancer Institute has published consensus guidelines for universal screening for hereditary nonpolyposis colorectal cancer (HNPCC) in patients with newly diagnosed colorectal cancer.
To determine the cost-effectiveness of screening compared with standard care in eligible patients with colorectal cancer and their siblings and children.
Cost-effectiveness analysis.
National colorectal cancer registry data, the Creighton International Hereditary Colorectal Cancer Registry, Medicare claims records, and published literature.
Patients with newly diagnosed colorectal cancer and their siblings and children.
Lifetime (varies depending on age at screening).
Societal.
Initial office-based screening to determine eligibility (based on personal and family cancer history), followed by tumor testing for microsatellite instability. Those with microsatellite instability were offered genetic testing for HNPCC. Siblings and children of patients with cancer and the HNPCC mutation were offered genetic testing, and those who were found to carry the mutation received lifelong colorectal cancer screening.
Life-years gained.
RESULTS OF BASE-CASE ANALYSIS: When only the patients with cancer were considered, cost-effectiveness of screening was $42 210 per life-year gained. When patients with cancer and their siblings and children were considered together, cost-effectiveness increased to $7556 per life-year gained.
The model was most sensitive to the estimated survival gain from screening siblings and children, to the prevalence of HNPCC mutations among patients with newly diagnosed cancer, and to the discount rate. In probabilistic analysis, the 90% CI for the cost-effectiveness of screening patients with cancer plus their relatives was $4874 to $21 576 per life-year gained.
Screening patients with newly diagnosed colorectal cancer for HNPCC is cost-effective, especially if the benefits to their immediate relatives are considered.
美国国立癌症研究所已发布关于对新诊断为结直肠癌的患者进行遗传性非息肉病性结直肠癌（HNPCC）普遍筛查的共识指南。
确定在符合条件的结直肠癌患者及其兄弟姐妹和子女中，筛查与标准治疗相比的成本效益。
成本效益分析。
国家结直肠癌登记数据、克里顿国际遗传性结直肠癌登记处、医疗保险理赔记录以及已发表的文献。
新诊断为结直肠癌的患者及其兄弟姐妹和子女。
终身（因筛查时年龄而异）。
社会视角。
最初在门诊进行筛查以确定是否符合条件（基于个人和家族癌症病史），随后进行肿瘤微卫星不稳定性检测。对微卫星不稳定的患者进行HNPCC基因检测。癌症患者以及携带HNPCC突变的患者的兄弟姐妹和子女接受基因检测，被发现携带突变的人接受终身结直肠癌筛查。
获得的生命年数。
仅考虑癌症患者时，筛查的成本效益为每获得一个生命年42210美元。当将癌症患者及其兄弟姐妹和子女一起考虑时，成本效益增至每获得一个生命年7556美元。
该模型对筛查兄弟姐妹和子女估计的生存获益、新诊断癌症患者中HNPCC突变的患病率以及贴现率最为敏感。在概率分析中，筛查癌症患者及其亲属的成本效益的90%置信区间为每获得一个生命年4874美元至21576美元。
对新诊断为结直肠癌的患者进行HNPCC筛查具有成本效益，特别是如果考虑对其直系亲属的益处。
