1 Department of Radiation Oncology, Stanford Cancer Institute, Stanford University, Stanford, California, USA.
2 School of Medicine, Stanford University, Stanford, California, USA.
Otolaryngol Head Neck Surg. 2019 Jul;161(1):82-90. doi: 10.1177/0194599819832593. Epub 2019 Mar 5.
Most patients with nasopharyngeal carcinoma (NPC) in the United States are diagnosed with stage III-IV disease. Screening for NPC in endemic areas results in earlier detection and improved outcomes. We examined the cost-effectiveness of screening for NPC with plasma Epstein-Barr virus DNA among Asian American men in the United States.
We used a Markov cohort model to estimate discounted life-years, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios for screening as compared with usual care without screening.
The base case analysis considered onetime screening for 50-year-old Asian American men.
Confirmatory testing was magnetic resonance imaging and nasopharyngoscopy. Cancer-specific outcomes, health utility values, and costs were determined from cancer registries and the published literature.
For Asian American men, usual care without screening resulted in the detection of NPC at stages I, II, III-IVB, and IVC among 6%, 29%, 54%, and 11% of those with cancer, respectively, whereas screening resulted in earlier detection with a stage distribution of 43%, 24%, 32%, and 1%. This corresponded to an additional 0.00055 QALYs gained at a cost of $63 per person: an incremental cost of $113,341 per QALY gained. In probabilistic sensitivity analysis, screening Asian American men was cost-effective at $100,000 per QALY gained in 35% of samples.
Although screening for NPC with plasma Epstein-Barr virus DNA for 50-year-old Asian American men may result in earlier detection, in this study it was unlikely to be cost-effective. Screening may be reasonable for certain subpopulations at higher risk for NPC, but clinical studies are necessary before implementation.
大多数美国的鼻咽癌（NPC）患者被诊断为 III-IV 期疾病。在鼻咽癌高发地区进行筛查可更早发现疾病，改善预后。我们研究了对美国亚裔男性进行血浆 Epstein-Barr 病毒 DNA 筛查 NPC 的成本效益。
我们使用马尔可夫队列模型，估算了筛查与不筛查的常规治疗相比，筛查为亚裔美国男性带来的折扣生命年、质量调整生命年（QALY）、成本和增量成本效益比。
基础分析考虑对 50 岁的亚裔美国男性进行一次性筛查。
确认性检测为磁共振成像和鼻咽镜检查。癌症特异性结局、健康效用值和成本来自癌症登记处和已发表的文献。
对于亚裔美国男性，不筛查的常规治疗分别导致 I 期、II 期、III-IVB 期和 IVC 期 NPC 在有癌症患者中的检出率为 6%、29%、54%和 11%，而筛查导致更早检出，分期分布为 43%、24%、32%和 1%。这对应于每人多获得 0.00055 个 QALY，成本为每人 63 美元：增量成本为每获得一个 QALY 增加 113341 美元。在概率敏感性分析中，在 35%的样本中，对 50 岁的亚裔美国男性进行 NPC 筛查的成本效益为每 QALY 增加 10 万美元。
虽然对 50 岁的亚裔美国男性进行血浆 Epstein-Barr 病毒 DNA 筛查可能会更早发现 NPC，但在本研究中，这种筛查不太可能具有成本效益。对于某些 NPC 风险较高的亚人群，筛查可能是合理的，但在实施之前需要进行临床研究。
