Coyle Kathryn, Carrier Marc, Lazo-Langner Alejandro, Shivakumar Sudeep, Zarychanski Ryan, Tagalakis Vicky, Solymoss Susan, Routhier Nathalie, Douketis James, Coyle Douglas
Brunel University, Uxbridge, Middlesex, United Kingdom, Kingston Ln, Uxbridge UB8 3PH, United Kingdom.
University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada; Ottawa Hospital Research Institute, Ottawa Hospital, 725 Parkdale Avenue, Ottawa, ON K1Y 4E9, Canada.
Thromb Res. 2017 Mar;151:67-71. doi: 10.1016/j.thromres.2017.01.007. Epub 2017 Jan 25.
Unprovoked venous thromboembolism (VTE) can be the first manifestation of cancer. It is unclear if extensive screening for occult cancer including a comprehensive computed tomography (CT) scan of the abdomen/pelvis is cost-effective in this patient population.
To assess the health care related costs, number of missed cancer cases and health related utility values of a limited screening strategy with and without the addition of a comprehensive CT scan of the abdomen/pelvis and to identify to what extent testing should be done in these circumstances to allow early detection of occult cancers.
Cost effectiveness analysis using data that was collected alongside the SOME randomized controlled trial which compared an extensive occult cancer screening including a CT of the abdomen/pelvis to a more limited screening strategy in patients with a first unprovoked VTE, was used for the current analyses.
Analyses were conducted with a one-year time horizon from a Canadian health care perspective. Primary analysis was based on complete cases, with sensitivity analysis using appropriate multiple imputation methods to account for missing data.
Data from a total of 854 patients with a first unprovoked VTE were included in these analyses. The addition of a comprehensive CT scan was associated with higher costs ($551 CDN) with no improvement in utility values or number of missed cancers. Results were consistent when adopting multiple imputation methods.
The addition of a comprehensive CT scan of the abdomen/pelvis for the screening of occult cancer in patients with unprovoked VTE is not cost effective, as it is both more costly and not more effective in detecting occult cancer.
不明原因的静脉血栓栓塞症（VTE）可能是癌症的首发表现。对于这一患者群体，包括对腹部/盆腔进行全面计算机断层扫描（CT）在内的隐匿性癌症广泛筛查是否具有成本效益尚不清楚。
评估在有限筛查策略基础上增加或不增加腹部/盆腔全面CT扫描时的医疗相关成本、漏诊癌症病例数以及健康相关效用值，并确定在这些情况下应进行何种程度的检测以实现隐匿性癌症的早期发现。
使用在SOME随机对照试验中收集的数据进行成本效益分析，该试验将包括腹部/盆腔CT的广泛隐匿性癌症筛查与首次不明原因VTE患者的更有限筛查策略进行了比较，当前分析采用了这些数据。
从加拿大医疗保健的角度，以一年时间范围进行分析。主要分析基于完整病例，采用适当的多重插补方法进行敏感性分析以处理缺失数据。
这些分析纳入了总共854例首次不明原因VTE患者的数据。增加全面CT扫描与更高的成本（551加元）相关，效用值或漏诊癌症病例数并无改善。采用多重插补方法时结果一致。
对于不明原因VTE患者，增加腹部/盆腔全面CT扫描用于隐匿性癌症筛查不具有成本效益，因为其成本更高且在检测隐匿性癌症方面并无更高效。
