Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH 45267, USA.
Am J Respir Crit Care Med. 2010 Jun 15;181(12):1376-82. doi: 10.1164/rccm.200910-1553OC. Epub 2010 Feb 18.
Women with pulmonary lymphangioleiomyomatosis (LAM) who present with a sentinel spontaneous pneumothorax (SPTX) will experience an average of 2.5 additional pneumothoraces. The diagnosis of LAM is typically delayed until after the second pneumothorax.
We hypothesized that targeted screening of an LAM-enriched population of nonsmoking women between the ages of 25 and 54 years, who present with a sentinel pneumothorax indicated by high-resolution computed tomography (HRCT), will facilitate early identification, definitive therapy, and improved quality of life for patients with LAM.
We constructed a Markov state-transition model to assess the cost-effectiveness of screening. Rates of SPTX and prevalence of LAM in populations stratified by age, sex, and smoking status were derived from the literature. Costs of testing and treatment were extracted from 2007 Medicare data. We compared a strategy based on HRCT screening followed by pleurodesis for patients with LAM, versus no HRCT screening.
The prevalence of LAM in nonsmoking women, between the ages of 25 and 54 years, with SPTX is estimated at 5% on the basis of the available literature. In our base case analysis, screening for LAM by HRCT is the most cost-effective strategy, with a marginal cost-effectiveness ratio of $32,980 per quality-adjusted life-year gained. Sensitivity analysis showed that HRCT screening remains cost-effective for groups in which the prevalence of LAM in the population subset screened is greater than 2.5%.
Screening for LAM by HRCT in nonsmoking women age 25-54 that present with SPTX is cost-effective. Physicians are advised to screen for LAM by HRCT in this population.
患有肺淋巴管平滑肌瘤病（LAM）并出现首发自发性气胸（SPTX）的女性平均会经历 2.5 次额外气胸。LAM 的诊断通常要等到第二次气胸后才能做出。
我们假设对年龄在 25 至 54 岁之间、因高分辨率计算机断层扫描（HRCT）提示首发气胸的、富含 LAM 的非吸烟女性人群进行 LAM 靶向筛查，将有助于早期发现、明确治疗并改善 LAM 患者的生活质量。
我们构建了一个马尔可夫状态转移模型来评估筛查的成本效益。根据文献，通过年龄、性别和吸烟状况分层的人群中 SPTX 和 LAM 的发生率，以及从 2007 年医疗保险数据中提取的测试和治疗成本，来构建模型。我们比较了基于 HRCT 筛查后行胸膜固定术治疗 LAM 患者的策略，与不进行 HRCT 筛查的策略。
根据现有文献，非吸烟女性、年龄在 25 至 54 岁之间、首发气胸的患者中 LAM 的患病率估计为 5%。在我们的基本案例分析中，HRCT 筛查 LAM 是最具成本效益的策略，每获得一个质量调整生命年的边际成本效益比为 32980 美元。敏感性分析表明，在 HRCT 筛查人群中 LAM 的患病率大于 2.5%的情况下，HRCT 筛查仍然具有成本效益。
对年龄在 25-54 岁、首发气胸的非吸烟女性进行 HRCT 筛查 LAM 具有成本效益。建议医生在该人群中通过 HRCT 筛查 LAM。
