Guadagnolo Beverly A, Punglia Rinaa S, Kuntz Karen M, Mauch Peter M, Ng Andrea K
Joint Center for Radiation Therapy/Harvard Radiation Oncology Program, Harvard School of Public Health, Harvard University, Boston, MA 02215, USA.
J Clin Oncol. 2006 Sep 1;24(25):4116-22. doi: 10.1200/JCO.2006.07.0409.
To estimate the clinical benefits and cost effectiveness of computed tomography (CT) in the follow-up of patients with complete response (CR) after treatment for Hodgkin's disease (HD).
We developed a decision-analytic model to evaluate follow-up strategies for two hypothetical cohorts of 25-year-old patients with stage I-II or stage III-IV HD, treated with doxorubicin, bleomycin, vinblastine, and dacarbazine-based chemotherapy with or without radiation therapy, respectively. We compared three strategies for observing asymptomatic patients after CR: routine annual CT for 10 years, annual CT for 5 years, or follow-up with non-CT modalities only. We used Markov models to calculate life expectancy, quality-adjusted life expectancy, and lifetime costs. Baseline probabilities, transition probabilities, and utilities were derived from published studies. Cost data were derived from the Medicare fee schedule and medical literature. We performed sensitivity analyses by varying baseline estimates.
Annual CT follow-up is associated with minimal survival benefit. With adjustments for quality of life, we found a decrement in quality-adjusted life expectancy for early-stage patients followed with CT compared with non-CT modalities. Sensitivity analyses showed annual CT for 5 years becomes more effective than non-CT follow-up if the specificity of CT is 80% or more or if the disutility associated with a false-positive CT result is less than 0.01 quality-adjusted life years (QALYs). For advanced-stage patients, annual CT for 5 years is associated with a very small quality-adjusted survival gain over non-CT follow-up with an incremental cost-effectiveness ratio of 9,042,300 dollars/QALY.
Our analysis suggests that routine CT should not be used in the surveillance of asymptomatic patients in CR after treatment for HD.
评估计算机断层扫描（CT）在霍奇金淋巴瘤（HD）治疗后完全缓解（CR）患者随访中的临床益处和成本效益。
我们建立了一个决策分析模型，以评估两个假设队列中25岁I-II期或III-IV期HD患者的随访策略，这两个队列分别接受了以多柔比星、博来霉素、长春花碱和达卡巴嗪为基础的化疗，部分患者接受或未接受放射治疗。我们比较了CR后观察无症状患者的三种策略：10年每年进行常规CT检查、5年每年进行CT检查或仅采用非CT检查方式进行随访。我们使用马尔可夫模型来计算预期寿命、质量调整预期寿命和终生成本。基线概率、转移概率和效用值均来自已发表的研究。成本数据来自医疗保险费用清单和医学文献。我们通过改变基线估计值进行敏感性分析。
每年进行CT随访带来的生存益处极小。在对生活质量进行调整后，我们发现与非CT检查方式相比，接受CT随访的早期患者的质量调整预期寿命有所下降。敏感性分析表明，如果CT的特异性为80%或更高，或者与CT假阳性结果相关的负效用小于0.01质量调整生命年（QALY），那么每年进行5年CT检查比非CT随访更有效。对于晚期患者，与非CT随访相比，每年进行5年CT检查带来的质量调整生存获益非常小，增量成本效益比为9,042,300美元/QALY。
我们的分析表明，在HD治疗后CR的无症状患者监测中不应使用常规CT。
