关于识别遗传性非息肉病性结直肠癌患者的替代策略的经济学观点。
An economic viewpoint on alternative strategies for identifying persons with hereditary nonpolyposis colorectal cancer.
作者信息
Ramsey Scott D, Burke Wylie, Clarke Lauren
机构信息
Fred Hutchinson Cancer Research Center, and Department of Medicine, University of Washington, Seattle, Washington, USA.
出版信息
Genet Med. 2003 Sep-Oct;5(5):353-63. doi: 10.1097/01.GIM.0000086626.03082.B5.
Abstract
PURPOSE
There is uncertainty regarding the optimal strategy for identifying mutation carriers among those with hereditary nonpolyposis colorectal cancer (HNPCC).
METHODS
We used decision analysis to compare the cost-effectiveness of 4 strategies among those with newly diagnosed colon cancer: (1) clinical and family history followed by microsatellite instability testing and germline testing (Bethesda guidelines); (2) universal microsatellite instability testing; (3) germline testing of those who meet clinical and family history criteria; and (4) universal germline testing.
RESULTS
The added cost per year of life saved (YLS) for each strategy was as follows: (1) 11,865 US dollars/YLS, (2) 35,617 US dollars/YLS, (3) 49,702 US dollars/YLS, and (4) 267,548 US dollars/YLS.
CONCLUSIONS
The Bethesda guidelines are the most cost-effectiveness approach to screen persons for HNPCC.
摘要
目的
在遗传性非息肉病性结直肠癌（HNPCC）患者中，确定突变携带者的最佳策略尚存在不确定性。
方法
我们采用决策分析方法，比较了4种策略在新诊断结肠癌患者中的成本效益：（1）临床和家族史评估，随后进行微卫星不稳定性检测和种系检测（贝塞斯达指南）；（2）普遍进行微卫星不稳定性检测；（3）对符合临床和家族史标准的患者进行种系检测；（4）普遍进行种系检测。
结果
每种策略每挽救一年生命（YLS）的额外成本如下：（1）11,865美元/YLS，（2）35,617美元/YLS，（3）49,702美元/YLS，（4）267,548美元/YLS。
结论
贝塞斯达指南是筛查HNPCC患者最具成本效益的方法。
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