BRCA1 基因突变携带者的乳腺磁共振成像与屏片式乳腺 X 线摄影筛查的成本效益比较。
Cost-effectiveness of breast MR imaging and screen-film mammography for screening BRCA1 gene mutation carriers.
机构信息
Department of Radiology, Institute for Technology Assessment, Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114, USA.
出版信息
Radiology. 2010 Mar;254(3):793-800. doi: 10.1148/radiol.09091086.
PURPOSE
To evaluate the clinical effectiveness and cost-effectiveness of screening strategies in which MR imaging and screen-film mammography were used, alone and in combination, in women with BRCA1 mutations.
MATERIALS AND METHODS
Because this study did not involve primary data collection from individual patients, institutional review board approval was not needed. By using a simulation model, we compared three annual screening strategies for a cohort of 25-year-old BRCA1 mutation carriers, as follows: (a) screen-film mammography, (b) MR imaging, and (c) combined MR imaging and screen-film mammography (combined screening). The model was used to estimate quality-adjusted life-years (QALYs) and lifetime costs. Incremental cost-effectiveness ratios were calculated. Input parameters were obtained from the medical literature, existing databases, and calibration. Costs (2007 U.S. dollars) and quality-of-life adjustments were derived from Medicare reimbursement rates and the medical literature. Sensitivity analysis was performed to evaluate the effect of uncertainty in parameter estimates on model results.
RESULTS
In the base-case analysis, annual combined screening was most effective (44.62 QALYs), and had the highest cost ($110973), followed by annual MR imaging alone (44.50 QALYs, $108641), and annual mammography alone (44.46 QALYs, $100336). Adding annual MR imaging to annual mammographic screening cost $69125 for each additional QALY gained. Sensitivity analysis indicated that, when the screening MR imaging cost increased to $960 (base case, $577), or breast cancer risk by age 70 years decreased below 58% (base case, 65%), or the sensitivity of combined screening decreased below 76% (base case, 94%), the cost of adding MR imaging to mammography exceeded $100000 per QALY.
CONCLUSION
Annual combined screening provides the greatest life expectancy and is likely cost-effective when the value placed on gaining an additional QALY is in the range of $50000-$100000.
SUPPLEMENTAL MATERIAL
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09091086/-/DC1.
目的
评估在携带 BRCA1 突变的女性中单独或联合使用磁共振成像（MR 成像）和屏片乳腺摄影进行筛查的策略的临床效果和成本效益。
材料与方法
由于本研究未涉及个体患者的原始数据收集，因此无需机构审查委员会批准。我们通过使用仿真模型，比较了 25 岁 BRCA1 突变携带者的三种年度筛查策略，如下：（a）屏片乳腺摄影；（b）MR 成像；（c）MR 成像联合屏片乳腺摄影（联合筛查）。该模型用于估计质量调整生命年（QALY）和终生成本。计算增量成本效益比。输入参数来自医学文献、现有数据库和校准。成本（2007 年美元）和生活质量调整来自医疗保险报销率和医学文献。进行敏感性分析以评估参数估计不确定性对模型结果的影响。
结果
在基本案例分析中，年度联合筛查最有效（44.62 QALY），成本最高（110973 美元），其次是单独的年度 MR 成像（44.50 QALY，108641 美元）和单独的年度乳腺摄影（44.46 QALY，100336 美元）。每年增加 MR 成像检查可为每增加一个 QALY 增加 69125 美元的成本。敏感性分析表明，当筛查性 MR 成像成本增加到 960 美元（基础病例为 577 美元），或 70 岁时乳腺癌风险降至 58%以下（基础病例为 65%），或联合筛查的敏感性降至 76%以下（基础病例为 94%）时，将 MR 成像添加到乳腺摄影中的成本超过每个 QALY 100000 美元。
结论
当每增加一个 QALY 的价值在 50000 美元至 100000 美元之间时，每年联合筛查提供最长的预期寿命，并且可能具有成本效益。
补充材料
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09091086/-/DC1.
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