Hörster Laura, Schlenk Richard F, Stadler Michael, Gabriel Maria, Thol Felicitas, Schildmann Jan, Vollmann Jochen, Rochau Ursula, Sroczynski Gaby, Wasem Jürgen, Ganser Arnold, Port Matthias, Neumann Anja
Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, 45127 Essen, Germany.
Department of Internal Medicine III, University of Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
Leuk Res. 2017 Nov;62:84-90. doi: 10.1016/j.leukres.2017.09.009. Epub 2017 Sep 19.
During the last years, molecular genetic data are increasingly used as prognostic and predictive factors in acute myeloid leukemia (AML). The molecular genetic profile permits a rapid risk categorization and beyond that a prediction of differential treatment efficacy of post-remission chemotherapy versus an allogeneic hematopoietic cell transplantation (HCT) in specific subgroups.
The aim of this study was to evaluate cost-effectiveness of two different strategies of risk categorization (conventional cytogenetic diagnostics (CCD) versus molecular genetic diagnostics (MGD)) in patients with AML, using a decision-analytic state-transition model. The model is run as (Monte Carlo) microsimulation in which individuals pass through in cycles with a cycle length of one month and a time horizon of ten years.
Results show that on average, individuals within the MGD group generated about US$ 32,000 higher costs but survived about seven months longer than individuals within the CCD group. This leads to an Incremental Cost-Effectiveness Ratio (ICER) of about US$ 4928 per survived month.
With a GDP (Gross Domestic Product) of US$ 26,467 (€ 33,630) per capita in Germany in 2012, the base-case ICER of US$ 4928 per survived month projected to US$ 59,136 per survived year is in between the simple GDP and the three times GDP per capita.
在过去几年中，分子遗传学数据越来越多地被用作急性髓系白血病（AML）的预后和预测因素。分子遗传学特征不仅能实现快速风险分类，还能预测特定亚组中缓解后化疗与异基因造血细胞移植（HCT）的不同治疗效果。
本研究旨在使用决策分析状态转换模型，评估AML患者两种不同风险分类策略（传统细胞遗传学诊断（CCD）与分子遗传学诊断（MGD））的成本效益。该模型以（蒙特卡洛）微观模拟运行，个体以每月为一个周期、十年为时间跨度循环经历各个阶段。
结果显示，平均而言，MGD组个体产生的成本比CCD组个体高出约32,000美元，但存活时间比CCD组个体长约七个月。这导致每存活一个月的增量成本效益比（ICER）约为4928美元。
2012年德国人均国内生产总值（GDP）为26,467美元（33,630欧元），每存活一个月4928美元的基础情况ICER换算为每存活一年59,136美元，介于简单GDP和人均GDP的三倍之间。
