Cheung Kevin, Roman Sanziana A, Wang Tracy S, Walker Hugh D, Sosa Julie Ann
Department of Surgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
J Clin Endocrinol Metab. 2008 Jun;93(6):2173-80. doi: 10.1210/jc.2007-2496. Epub 2008 Mar 25.
European studies have shown that the use of routine calcitonin screening for detection of medullary thyroid cancer (MTC) in patients with thyroid nodules increases the detection of occult MTC and may improve patient outcomes. Calcitonin screening for MTC has not been recommended in recent U.S. practice guidelines.
Our objective was to determine the cost-effectiveness (C/E) of routine calcitonin screening in adult patients with thyroid nodules in the United States.
SETTINGS/SUBJECTS: A decision model was developed for a hypothetical group of adult patients presenting for evaluation of thyroid nodules in the United States. Patients were screened using current American Thyroid Association guidelines only, or American Thyroid Association guidelines with routine serum calcitonin screening. Input data were obtained from the literature, the Surveillance Epidemiology and End Results and Healthcare Cost and Utilization Project's Nationwide Inpatient Sample databases, and the Medicare Reimbursement Schedule. Sensitivity analyses were performed for a number of input variables.
C/E, measured in dollars per life years saved (LYS), was calculated.
Addition of calcitonin screening to current American Thyroid Association guidelines for the evaluation of thyroid nodules would cost $11,793 per LYS ($10,941-$12,646). When extrapolated to the national level, calcitonin screening for MTC in the United States would yield an additional 113,000 life years at a cost increase of 5.3%. Calcitonin screening C/E is sensitive to patient age and gender, and to changes in disease prevalence, specificity of fine needle aspiration and calcitonin testing, calcitonin screening level, costs of testing, and length of follow-up.
Routine serum calcitonin screening in patients undergoing evaluation for thyroid nodules appears to be cost effective in the United States, with C/E comparable to the measurement of thyroid stimulating hormone, colonoscopy, and mammography screening.
欧洲的研究表明，对甲状腺结节患者进行降钙素常规筛查以检测甲状腺髓样癌（MTC），可增加隐匿性MTC的检出率，并可能改善患者预后。美国近期的实践指南未推荐对MTC进行降钙素筛查。
我们的目的是确定在美国对成年甲状腺结节患者进行常规降钙素筛查的成本效益（C/E）。
设置/研究对象：针对在美国就诊评估甲状腺结节的一组假设成年患者建立了决策模型。患者仅按照美国甲状腺协会现行指南进行筛查，或按照美国甲状腺协会指南并进行常规血清降钙素筛查。输入数据来自文献、监测、流行病学和最终结果以及医疗保健成本与利用项目的全国住院患者样本数据库，以及医疗保险报销时间表。对多个输入变量进行了敏感性分析。
计算以每挽救生命年（LYS）的美元数衡量的C/E。
在当前美国甲状腺协会评估甲状腺结节的指南中增加降钙素筛查，每LYS的成本为11,793美元（10,941 - 12,646美元）。 extrapolated to the national level, calcitonin screening for MTC in the United States would yield an additional 113,000 life years at a cost increase of 5.3%.降钙素筛查的C/E对患者年龄和性别、疾病患病率变化、细针穿刺和降钙素检测的特异性、降钙素筛查水平、检测成本以及随访时间敏感。
在美国，对接受甲状腺结节评估的患者进行常规血清降钙素筛查似乎具有成本效益，其C/E与促甲状腺激素检测、结肠镜检查和乳腺X线筛查相当。 （注：原文中“extrapolated to the national level, calcitonin screening for MTC in the United States would yield an additional 113,000 life years at a cost increase of 5.3%.”这句话似乎表述不完整或有误，翻译时保留了原文。）
