可否基于成本效益分析结果，推荐使用基因型指导的阿司匹林用于结直肠癌一级预防？
Can Cost-effectiveness Analysis Inform Genotype-Guided Aspirin Use for Primary Colorectal Cancer Prevention?
机构信息
Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, Utah.
Program in Personalized Health, University of Utah, Salt Lake City, Utah.
出版信息
Cancer Epidemiol Biomarkers Prev. 2021 Jun;30(6):1106-1113. doi: 10.1158/1055-9965.EPI-19-1580. Epub 2021 Apr 13.
BACKGROUND
Inherited genetic variants can modify the cancer-chemopreventive effect of aspirin. We evaluated the clinical and economic value of genotype-guided aspirin use for colorectal cancer chemoprevention in average-risk individuals.
METHODS
A decision analytical model compared genotype-guided aspirin use versus no genetic testing, no aspirin. The model simulated 100,000 adults ≥50 years of age with average colorectal cancer and cardiovascular disease risk. Low-dose aspirin daily starting at age 50 years was recommended only for those with a genetic test result indicating a greater reduction in colorectal cancer risk with aspirin use. The primary outcomes were quality-adjusted life-years (QALY), costs, and incremental cost-effectiveness ratio (ICER).
RESULTS
The mean cost of using genotype-guided aspirin was $187,109 with 19.922 mean QALYs compared with $186,464 with 19.912 QALYs for no genetic testing, no aspirin. Genotype-guided aspirin yielded an ICER of $66,243 per QALY gained, and was cost-effective in 58% of simulations at the $100,000 willingness-to-pay threshold. Genotype-guided aspirin was associated with 1,461 fewer polyps developed, 510 fewer colorectal cancer cases, and 181 fewer colorectal cancer-related deaths. This strategy prevented 1,078 myocardial infarctions with 1,430 gastrointestinal bleeding events, and 323 intracranial hemorrhage cases compared with no genetic testing, no aspirin.
CONCLUSIONS
Genotype-guided aspirin use for colorectal cancer chemoprevention may offer a cost-effective approach for the future management of average-risk individuals.
IMPACT
A genotype-guided aspirin strategy may prevent colorectal cancer, colorectal cancer-related deaths, and myocardial infarctions, while minimizing bleeding adverse events. This model establishes a framework for genetically-guided aspirin use for targeted chemoprevention of colorectal cancer with application toward commercial testing in this population.
背景
遗传变异可改变阿司匹林的癌症化学预防作用。我们评估了基因型指导下使用阿司匹林预防结直肠癌的临床和经济价值，对象为一般风险人群。
方法
决策分析模型比较了基因型指导下使用阿司匹林与不进行基因检测和不使用阿司匹林的情况。模型模拟了 10 万名 50 岁以上、结直肠癌和心血管疾病风险处于平均水平的成年人。仅对基因检测结果显示阿司匹林使用能更大程度降低结直肠癌风险的人群推荐每日低剂量阿司匹林（50 岁开始服用）。主要结局指标为质量调整生命年（QALY）、成本和增量成本效益比（ICER）。
结果
与不进行基因检测、不使用阿司匹林相比，使用基因型指导下阿司匹林的平均成本为 187109 美元，平均 QALY 为 19.922；不进行基因检测、不使用阿司匹林的平均成本为 186464 美元，平均 QALY 为 19.912。基因型指导下使用阿司匹林的 ICER 为每获得 1 个 QALY 需 66243 美元，在 100000 美元意愿支付阈值下，有 58%的模拟情况具有成本效益。该策略可使 1461 个息肉、510 例结直肠癌和 181 例结直肠癌相关死亡减少。与不进行基因检测、不使用阿司匹林相比，该策略可预防 1078 例心肌梗死、1430 例胃肠道出血和 323 例颅内出血。
结论
基因型指导下使用阿司匹林预防结直肠癌可能为一般风险人群的未来管理提供一种具有成本效益的方法。
意义
基因型指导下的阿司匹林策略可预防结直肠癌、结直肠癌相关死亡和心肌梗死，同时最大限度地减少出血不良事件。该模型为基于基因的阿司匹林在结直肠癌靶向化学预防中的应用奠定了框架，适用于该人群的商业检测。
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