Speroff T, Dawson N V, Speroff L, Haber R J
Department of Epidemiology and Biostatistics, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio.
Am J Obstet Gynecol. 1991 Jan;164(1 Pt 1):165-74. doi: 10.1016/0002-9378(91)90649-c.
A bilateral oophorectomy at the time of elective hysterectomy is often performed to prevent ovarian cancer. The assumption that endogenous estrogen can be easily replaced with supplemental medication fosters the decision for routine oophorectomy. Published reports on the use of postmenopausal estrogen indicate that compliance is less than perfect. This fact could affect the overall outcome. Decision analysis techniques with Markov cohort modeling were used to evaluate the policy of elective bilateral oophorectomy. Results from studies judged methodologically sound were combined to determine values representing the influence of estrogen on coronary heart disease, breast cancer, and osteoporotic fracture. The decision tree also explicitly incorporated patient compliance. When compliance with estrogen therapy is assumed to be perfect, oophorectomy yields longer life expectancy than retaining the ovaries. When actual drug-taking behavior is considered, retaining the ovaries results in longer survival. This analysis highlights the importance of including the effects of patient compliance with treatment recommendations when the impact of a health policy decision such as prophylactic surgery is assessed.
在择期子宫切除时进行双侧卵巢切除术通常是为了预防卵巢癌。认为内源性雌激素可轻易被补充药物替代的假设促使了常规卵巢切除术的决定。关于绝经后雌激素使用的已发表报告表明，依从性并不理想。这一事实可能会影响总体结果。采用马尔可夫队列模型的决策分析技术来评估择期双侧卵巢切除术的策略。将方法学上合理的研究结果合并起来，以确定代表雌激素对冠心病、乳腺癌和骨质疏松性骨折影响的数值。决策树还明确纳入了患者的依从性。当假定雌激素治疗的依从性完美时，卵巢切除术比保留卵巢能带来更长的预期寿命。当考虑实际服药行为时，保留卵巢会导致更长的生存期。该分析突出了在评估诸如预防性手术等健康政策决策的影响时，纳入患者对治疗建议依从性影响的重要性。
