School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands.
PLoS One. 2019 Jul 24;14(7):e0220148. doi: 10.1371/journal.pone.0220148. eCollection 2019.
Disutility allows to identify how much population values intervention-related harms contributing to knowledge on the benefits/harms ratio of cancer screening programs. This systematic review evaluates disutility related to cancer screening applying a utility theory framework.
Using a predefined protocol, Embase, Medline Ovid, Web of Science, Cochrane, Google scholar and supplementary sources were systematically searched. The framework grouped disutilities associated with breast, cervical, lung, colorectal, and prostate cancer screening programs into the screening, diagnostic work up, and treatment phases. We assessed the quality of included studies according to the relevance to target population, risk of bias, appropriateness of measure and the time frame.
Out of 2840 hits, we included 38 studies, of which 27 measured (and others estimated) disutilities. Around 70% of studies had medium to high-level quality. Measured disutilities and Quality Adjusted Life Years loss were 0-0.03 and 0-0.0013 respectively in screening phases. Both disutilities and Quality Adjusted Life Years loss had similar ranges in diagnostic work up (0-0.26), and treatment (0.09-0.27) phases. We found no measured disutilities available for lung cancer screening and-little evidence for disutilities in treatment phase. Almost 40% of the estimated disutility values were above the range of measured ones.
Cancer screening programs led to low disutities related to screening phase, and low to moderate disutilities related to diagnostic work up and treatment phases. These disutility values varied by the measurement instrument applied, and were higher in studies with lower quality. The estimated disutility values comparing to the measured ones tended to overestimate the harms.
失效率可用于确定人群对干预相关危害的重视程度，从而了解癌症筛查计划的效益/危害比。本系统评价运用效用理论框架评估与癌症筛查相关的失效率。
使用预定义方案，系统检索了 Embase、Medline Ovid、Web of Science、Cochrane、Google scholar 和补充资源。该框架将与乳腺癌、宫颈癌、肺癌、结直肠癌和前列腺癌筛查计划相关的失效率分组为筛查、诊断工作和治疗阶段。我们根据与目标人群的相关性、偏倚风险、测量方法的适当性和时间框架来评估纳入研究的质量。
在 2840 项研究中，我们纳入了 38 项研究，其中 27 项研究测量了（和其他研究估计了）失效率。约 70%的研究具有中高度质量。在筛查阶段，测量的失效率和质量调整生命年损失分别为 0-0.03 和 0-0.0013。在诊断工作和治疗阶段，失效率和质量调整生命年损失的范围相似（0-0.26）和（0.09-0.27）。我们没有发现可用于肺癌筛查的测量失效率，而且在治疗阶段的失效率证据也很少。近 40%的估计失效率值高于测量值的范围。
癌症筛查计划导致与筛查阶段相关的低失效率，以及与诊断工作和治疗阶段相关的低至中度失效率。这些失效率值因应用的测量工具而异，且在质量较低的研究中较高。与测量值相比，估计的失效率值倾向于高估危害。
