Gynecologic Oncology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Gastro-enterology, Tel Aviv Sourasky Medical Center, Coller School of Management and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Cancer Prev Res (Phila). 2021 Apr;14(4):455-462. doi: 10.1158/1940-6207.CAPR-20-0411. Epub 2020 Dec 22.
With the growing technical ease and reduction in genetic screening costs, whole population screening may be a feasible option. Our objective was to investigate the cost effectiveness of whole population screening for mutations in Israel, for varying degrees of carrier state. Lifetime costs of whole female population screening for mutation carrier state versus nonscreening were compared using a Markovian process decision analysis model. Model parameters including ovarian and breast cancer risks were obtained from previously published data. Screening and other treatment-related costs were received from the Israeli Ministry of Health pricing list according to specified codes. Quality-adjusted life years were used for cost-effectiveness analysis. Sensitivity analysis was conducted to evaluate model uncertainties, specifically varying degrees of prevalence. Results show that whole population screening in Israel is cost effective across a wide range of prevalence rates with an incremental cost-effectiveness ratio of 81,493 new Israeli Shekels for a prevalence of 2.5%, increasing to 250,000 new Israeli Shekels for a 0.75% prevalence rate, per quality-adjusted life year gained. Discount rate and population prevalence and rate of risk reduction salpingo-oophorectomy are the most influential parameters in the model. Whole population screening for mutations should be offered as part of general health screening strategies by national medical insurance providers, even for non-Ashkenazi Jews. Our algorithm can be applied for other countries, adjusting local costs of screening and treatment. PREVENTION RELEVANCE: Whole population mutation screening in Israel is cost effective across a wide prevalence rate and should be offered as part of general health screening strategies by national medical insurance providers for cancer prevention.
随着技术的日益简便和基因筛查成本的降低，整个人群筛查可能是一种可行的选择。我们的目的是研究在以色列，针对不同程度的携带者状态，进行整个人群筛查 突变的成本效益。使用马尔可夫过程决策分析模型，比较了对 突变携带者状态进行全女性人群筛查与不筛查的终生成本。模型参数包括卵巢癌和乳腺癌风险，从先前发表的数据中获得。根据指定的代码，从以色列卫生部定价清单中获得筛查和其他治疗相关成本。使用质量调整生命年来进行成本效益分析。进行敏感性分析以评估模型的不确定性，特别是 突变的流行程度。结果表明，在以色列，整个人群 筛查在广泛的流行率范围内具有成本效益，增量成本效益比为每获得一个质量调整生命年 81493 新以色列谢克尔，对于 2.5%的流行率，增加到 250000 新以色列谢克尔，对于 0.75%的流行率。贴现率、人群 流行率和输卵管卵巢切除术风险降低率是模型中最具影响力的参数。整个人群筛查 突变应作为国家医疗保险提供者一般健康筛查策略的一部分提供，即使是非阿什肯纳兹犹太人。我们的算法可以应用于其他国家，调整当地的筛查和治疗成本。预防相关性：在以色列，整个人群 突变筛查在广泛的流行率范围内具有成本效益，应作为国家医疗保险提供者一般健康筛查策略的一部分提供，以预防癌症。
