Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Radiation Medicine Program, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
J Natl Cancer Inst. 2020 Jan 1;112(1):63-70. doi: 10.1093/jnci/djz037.
Adolescent women treated for Hodgkin lymphoma (HL) are at increased risk of breast cancer (BC). We evaluate the cost-utility of eight high-risk BC surveillance strategies for this population, including the Children's Oncology Group guideline of same-day annual mammography and magnetic resonance imaging (MRI) beginning at age 25 years.
A discrete event simulation model was used to simulate the life histories of a cohort of 500 000 25-year-old women treated for HL at age 15 years. We estimated BC incidence and mortality, life expectancy, quality-adjusted life-years (QALYs), health-care costs, and the relative cost-utility (incremental cost-utility ratio [ICUR]) under the eight assessed surveillance strategies. One-way sensitivity analysis enabled modeling of uncertainty evaluation. A publicly funded health-care payer perspective was adopted.
Costs across the eight screening strategies ranged from $32 643 to $43 739, whereas QALYs ranged from 24.419 to 24.480. In an incremental cost-effectiveness analysis, annual mammography beginning at age 25 years was associated with an ICUR of $43 000/QALY gained, annual MRI beginning at age 25 years with a switch to annual mammography at age 50 years had an ICUR of $148 000/QALY, and annual MRI beginning at age 25 years had an ICUR of $227 222/QALY. Among all assessed surveillance strategies, the differences in life expectancy were small.
Current high-risk BC surveillance guidelines do not reflect the most cost-effective strategy in survivors of adolescent HL. The results suggest that groups at high risk of BC may require high-risk surveillance guidelines that reflect their specific risk profile.
接受霍奇金淋巴瘤（HL）治疗的青少年女性患乳腺癌（BC）的风险增加。我们评估了针对该人群的 8 种高危 BC 监测策略的成本效益，包括儿童肿瘤学组（Children's Oncology Group）的指南，即从 25 岁开始，每天进行年度乳房 X 光检查和磁共振成像（MRI）。
使用离散事件模拟模型模拟了一组 500,000 名 15 岁时接受 HL 治疗的 25 岁女性的生命历程。我们估计了 BC 的发病率和死亡率、预期寿命、质量调整生命年（QALYs）、医疗保健成本，以及在八种评估的监测策略下的相对成本效益（增量成本效益比 [ICUR]）。单因素敏感性分析使不确定性评估得以建模。采用公共资助的医疗保健支付者视角。
八种筛查策略的成本范围为 32643 美元至 43739 美元，而 QALYs 范围为 24.419 至 24.480。在增量成本效益分析中，从 25 岁开始的年度乳房 X 光检查与每获得一个质量调整生命年的增量成本效益比为 43000 美元，从 25 岁开始的年度 MRI 检查与在 50 岁时转为年度乳房 X 光检查的策略相比，每获得一个质量调整生命年的增量成本效益比为 148000 美元，而从 25 岁开始的年度 MRI 检查的增量成本效益比为 227222 美元。在所有评估的监测策略中，预期寿命的差异很小。
目前的高危 BC 监测指南并未反映青少年 HL 幸存者中最具成本效益的策略。结果表明，BC 风险较高的群体可能需要反映其特定风险状况的高危监测指南。
