肺癌筛查中肺部 MRI 的成本效益。
Cost-effectiveness of lung MRI in lung cancer screening.
机构信息
Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, WI, USA.
出版信息
Eur Radiol. 2020 Mar;30(3):1738-1746. doi: 10.1007/s00330-019-06453-9. Epub 2019 Nov 20.
OBJECTIVES
Recent studies with lung MRI (MRI) have shown high sensitivity (Sn) and specificity (Sp) for lung nodule detection and characterization relative to low-dose CT (LDCT). Using this background data, we sought to compare the potential screening performance of MRI vs. LDCT using a Markov model of lung cancer screening.
METHODS
We created a Markov cohort model of lung cancer screening which incorporated lung cancer incidence, progression, and mortality based on gender, age, and smoking burden. Sensitivity (Sn) and Sp for LDCT were taken from the MISCAN Lung Microsimulation and Sn/Sp for MRI was estimated from a published substudy of the German Lung Cancer Screening and Intervention Trial. Screening, work-up, and treatment costs were estimated from published data. Screening with MRI and LDCT was simulated for a cohort of male and female smokers (2 packs per day; 36 pack/years of smoking history) starting at age 60. We calculated the screening performance and cost-effectiveness of MRI screening and performed a sensitivity analysis on MRI Sn/Sp and cost.
RESULTS
There was no difference in life expectancy between MRI and LDCT screening (males 13.28 vs. 13.29 life-years; females 14.22 vs. 14.22 life-years). MRI had a favorable cost-effectiveness ratio of $258,169 in men and $403,888 in women driven by fewer false-positive screens. On sensitivity analysis, MRI remained cost effective at screening costs < $396 dollars and Sp > 81%.
CONCLUSIONS
In this Markov model of lung cancer screening, MRI has a near-equivalent life expectancy benefit and has superior cost-effectiveness relative to LDCT.
KEY POINTS
• In this Markov model of lung cancer screening, there is no difference in mortality between yearly screening with MRI and low-dose CT. • Compared to low-dose CT, screening with MRI led to a reduction in false-positive studies from 26 to 2.8% in men and 26 to 2.6% in women. • Due to similar life-expectancy and reduced false-positive rate, we found a favorable cost-effectiveness ratio of $258,169 in men and $403,888 in women of MRI relative to low-dose CT.
目的
最近使用肺部 MRI（MRI）的研究显示，与低剂量 CT（LDCT）相比，肺部结节检测和特征描述具有较高的灵敏度（Sn）和特异性（Sp）。基于这些背景数据，我们试图使用肺癌筛查的马尔可夫模型比较 MRI 与 LDCT 的潜在筛查性能。
方法
我们创建了一个肺癌筛查的马尔可夫队列模型，该模型根据性别、年龄和吸烟量纳入了肺癌的发病率、进展和死亡率。LDCT 的灵敏度（Sn）和特异性（Sp）取自 MISCAN 肺部微模拟，MRI 的 Sn/Sp 则根据德国肺癌筛查和干预试验的一项子研究进行估计。筛查、检查和治疗费用则根据已发表的数据进行估算。对起始年龄为 60 岁的男性和女性吸烟者（每天 2 包；36 包/年吸烟史）进行 MRI 和 LDCT 筛查的模拟。我们计算了 MRI 筛查的筛查性能和成本效益，并对 MRI Sn/Sp 和成本进行了敏感性分析。
结果
MRI 和 LDCT 筛查的预期寿命没有差异（男性为 13.28 年与 13.29 年，女性为 14.22 年与 14.22 年）。由于假阳性筛查较少，MRI 的男性成本效益比为 258,169 美元，女性为 403,888 美元，具有较好的成本效益比。在敏感性分析中，MRI 在筛查成本<396 美元且 Sp>81%的情况下仍然具有成本效益。
结论
在这个肺癌筛查的马尔可夫模型中，MRI 在预期寿命方面的获益与 LDCT 相当，而在成本效益方面具有优势。
关键点
• 在这个肺癌筛查的马尔可夫模型中，每年进行 MRI 筛查与低剂量 CT 筛查的死亡率没有差异。• 与低剂量 CT 相比，MRI 筛查导致男性的假阳性率从 26%降至 2.8%，女性的假阳性率从 26%降至 2.6%。• 由于预期寿命相似且假阳性率降低，我们发现 MRI 相对于 LDCT 的男性和女性的成本效益比分别为 258,169 美元和 403,888 美元，具有有利的比值。
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