Groenewoud J H, Pijnappel R M, van den Akker-Van Marle M E, Birnie E, Buijs-van der Woude T, Mali W P Th M, de Koning H J, Buskens E
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
Br J Cancer. 2004 Jan 26;90(2):383-92. doi: 10.1038/sj.bjc.6601520.
This paper demonstrates that the introduction of large-core needle biopsy (LCNB) replacing needle-localised breast biopsy (NLBB) for nonpalpable (screen-detected) breast lesions could result in substantial cost savings at the expense of a possible slight increase in breast cancer mortality. The cost-effectiveness of LCNB and NLBB was estimated using a microsimulation model. The sensitivity of LCNB (0.97) and resource use and costs of LCNB and NLBB were derived from a multicentre consecutive cohort study among 973 women who consented in getting LCNB and NLBB, if LCNB was negative. Sensitivity analyses were performed. Replacing NLBB with LCNB would result in approximately six more breast cancer deaths per year (in a target population of 2.1 million women), or in 1000 extra life-years lost from breast cancer (effect over 100 years). The total costs of management of breast cancer (3% discounted) are estimated at pound 4676 million with NLBB; introducing LCNB would save pound 13 million. The incremental cost-effectiveness ratio of continued NLBB vs LCNB would be pound 12 482 per additional life-year gained (3% discounted); incremental costs range from pound -21 687 (low threshold for breast biopsy) to pound 74 378 (high sensitivity of LCNB).
本文表明，对于不可触及（筛查发现）的乳腺病变，采用大芯针活检（LCNB）取代针定位乳腺活检（NLBB）可能会大幅节省成本，但代价是乳腺癌死亡率可能略有上升。使用微观模拟模型评估了LCNB和NLBB的成本效益。LCNB的敏感性（0.97）以及LCNB和NLBB的资源使用和成本来自一项多中心连续队列研究，该研究涉及973名同意接受LCNB和NLBB（如果LCNB为阴性）的女性。进行了敏感性分析。用LCNB取代NLBB每年将导致约6例额外的乳腺癌死亡（在210万女性的目标人群中），或因乳腺癌导致额外1000个生命年的损失（100年的影响）。采用NLBB时，乳腺癌管理的总成本（3%贴现）估计为4.676亿英镑；引入LCNB将节省1300万英镑。继续采用NLBB与LCNB相比，每增加一个获得的生命年（3%贴现）的增量成本效益比为12482英镑；增量成本范围从-21687英镑（乳腺活检的低阈值）到74378英镑（LCNB的高敏感性）。
