Xie Feng, O'Reilly Daria, Ferrusi Ilia L, Blackhouse Gord, Bowen James M, Tarride Jean-Eric, Goeree Ron
Programs for Assessment of Technology in Health Research Institute, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
J Am Coll Radiol. 2009 May;6(5):317-23. doi: 10.1016/j.jacr.2009.01.022.
The aim of this paper is to present an economic evaluation of diagnostic technologies using Helicobacter pylori screening strategies for the prevention of gastric cancer as an illustration.
A Markov model was constructed to compare the lifetime cost and effectiveness of 4 potential strategies: no screening, the serology test by enzyme-linked immunosorbent assay (ELISA), the stool antigen test (SAT), and the (13)C-urea breath test (UBT) for the detection of H. pylori among a hypothetical cohort of 10,000 Canadian men aged 35 years. Special parameter consideration included the sensitivity and specificity of each screening strategy, which determined the model structure and treatment regimen. The primary outcome measured was the incremental cost-effectiveness ratio between the screening strategies and the no-screening strategy. Base-case analysis and probabilistic sensitivity analysis were performed using the point estimates of the parameters and Monte Carlo simulations, respectively.
Compared with the no-screening strategy in the base-case analysis, the incremental cost-effectiveness ratio was $33,000 per quality-adjusted life-year (QALY) for the ELISA, $29,800 per QALY for the SAT, and $50,400 per QALY for the UBT. The probabilistic sensitivity analysis revealed that the no-screening strategy was more cost effective if the willingness to pay (WTP) was <$20,000 per QALY, while the SAT had the highest probability of being cost effective if the WTP was >$30,000 per QALY. Both the ELISA and the UBT were not cost-effective strategies over a wide range of WTP values.
Although the UBT had the highest sensitivity and specificity, either no screening or the SAT could be the most cost-effective strategy depending on the WTP threshold values from an economic perspective. This highlights the importance of economic evaluations of diagnostic technologies.
本文旨在以使用幽门螺杆菌筛查策略预防胃癌为例，对诊断技术进行经济学评估。
构建马尔可夫模型，比较4种潜在策略的终生成本和效果：不筛查、酶联免疫吸附测定（ELISA）血清学检测、粪便抗原检测（SAT）以及针对10000名35岁加拿大男性的假设队列进行的检测幽门螺杆菌的碳-13尿素呼气试验（UBT）。特殊参数考量包括每种筛查策略的敏感性和特异性，这决定了模型结构和治疗方案。测量的主要结果是筛查策略与不筛查策略之间的增量成本效果比。分别使用参数的点估计值和蒙特卡洛模拟进行了基础病例分析和概率敏感性分析。
在基础病例分析中，与不筛查策略相比，ELISA的增量成本效果比为每质量调整生命年（QALY）33000美元，SAT为每QALY 29800美元，UBT为每QALY 50400美元。概率敏感性分析显示，如果支付意愿（WTP）低于每QALY 20000美元，不筛查策略更具成本效益；而如果WTP高于每QALY 30000美元，SAT具有最高的成本效益概率。在广泛的WTP值范围内，ELISA和UBT均不是具有成本效益的策略。
尽管UBT具有最高的敏感性和特异性，但从不经济角度来看，根据WTP阈值，不筛查或SAT可能是最具成本效益的策略。这凸显了对诊断技术进行经济学评估的重要性。
