Clinical Genetics Institute, Intermountain Healthcare, Salt Lake City, UT 84103, USA.
Am J Manag Care. 2011 Aug 1;17(8):e288-300.
To characterize the current state of evidence and apply simulation modeling to support decision making about provision and coverage of a Lynch syndrome (LS) screening program among colorectal cancer (CRC) patients in our integrated healthcare delivery system.
Application of multiple methods for synthesizing evidence guided by needs of our clinical and administrative decision makers.
Narrative and focused reviews, computerized simulation models of multiple screening options, queries of our electronic data warehouse, and extensive communication with decision makers.
Review of published evidence at the time of the study period revealed that screening unselected CRC patients for LS would likely cost less than $25,000 per life-year saved (compared with no screening) and that screening with immunohistochemistry is substantially more efficient than other options. Our simulation models suggest that not only does including BRAF mutation testing substantially improve efficiency but that adding methylation testing improves it further. We characterized a variety of other metrics that contributed not only to local decisions but to the broader evidence base on this topic.
The current state of evidence at the time of the study period suggests an LS screening program can be both effective in reducing mortality from CRC and cost-effective. However, direct evidence remains limited and multiple factors could threaten success of such a program. We have identified opportunities for optimizing the efficiency of available screening protocols. While there was enough evidence for our system to proceed with an LS screening program, we recognize the threats to program success and will prospectively collect outcome data supporting empirical examination of the program.
描述当前证据状况，并应用模拟建模来支持我们的综合医疗服务系统中关于结直肠癌（CRC）患者进行林奇综合征（LS）筛查计划的提供和覆盖范围的决策。
应用多种方法综合证据，以满足我们临床和行政决策者的需求。
叙述性和重点审查、多种筛查选择的计算机模拟模型、对我们的电子数据仓库的查询以及与决策者的广泛沟通。
在研究期间，对已发表证据的回顾表明，对未选择的 CRC 患者进行 LS 筛查可能花费不到 25,000 美元/每挽救一个生命年（与不筛查相比），并且免疫组织化学筛查比其他选择更有效率。我们的模拟模型表明，不仅包括 BRAF 突变测试可以显著提高效率，而且添加甲基化测试可以进一步提高效率。我们还描述了其他各种指标，这些指标不仅有助于当地决策，还有助于这一主题的更广泛的证据基础。
在研究期间，当前证据状况表明，LS 筛查计划既能有效降低 CRC 死亡率，又具有成本效益。然而，直接证据仍然有限，并且多种因素可能威胁到该计划的成功。我们已经确定了优化现有筛查方案效率的机会。虽然我们的系统有足够的证据可以进行 LS 筛查计划，但我们认识到计划成功的威胁，并将前瞻性地收集支持对该计划进行实证检验的结果数据。
