生物标志物在心房颤动风险预测中的成本效益分析。
A Cost-Effectiveness Analysis of Biomarkers for Risk Prediction in Atrial Fibrillation.
机构信息
CHUM Research Center, Pavilion S, 850, St-Denis St., S03.300, Montreal, QC, H2X 0A9, Canada.
University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada.
出版信息
Mol Diagn Ther. 2023 May;27(3):383-394. doi: 10.1007/s40291-023-00639-0. Epub 2023 Jan 31.
RATIONALE
Atrial fibrillation (AF) is associated with an increased risk of thromboembolism. This risk is currently assessed with scoring systems based on clinical characteristics. However, these tools have limited prognostic performance. Circulating biomarkers are proposed for improved prediction of major clinical events and individualization of treatments in patients with AF.
OBJECTIVE
The aim was to assess the cost-effectiveness of precision medicine (PM), i.e., the use of combined biomarkers and clinical variables, in comparison to standard of care (SOC) for risk stratification in a hypothetical cohort of AF patients at risk of stroke.
METHODS
A Markov cohort model was developed to evaluate the costs and quality-adjusted life-years (QALYs) of PM compared to SOC, over 20 years using a Canadian healthcare system perspective.
RESULTS
PM decreased the mean per-patient overall costs by 7% ($94,932 vs $102,057 [Canadian dollars], respectively) and increased the QALYs by 12% (8.77 vs 7.68 QALYs, respectively). The calculated incremental cost-effectiveness ratio was negative, indicating that PM is an economically dominant strategy. These results were robust to one-way and probabilistic sensitivity analyses.
CONCLUSION
PM compared to SOC is economically dominant and is projected to generate cost savings.
背景
心房颤动（AF）与血栓栓塞风险增加相关。目前，该风险通过基于临床特征的评分系统进行评估。然而，这些工具的预后性能有限。循环生物标志物可用于改善 AF 患者的主要临床事件预测和治疗个体化。
目的
本研究旨在评估精准医学（PM），即联合生物标志物和临床变量的使用，与标准治疗（SOC）相比，在具有卒中风险的 AF 患者假设队列中进行风险分层的成本效益。
方法
使用加拿大医疗保健系统的观点，通过 Markov 队列模型来评估 PM 与 SOC 相比 20 年内的每位患者的总费用和质量调整生命年（QALYs）。
结果
PM 降低了每位患者的总体平均费用 7%（分别为 94932 加元和 102057 加元），并增加了 12%的 QALYs（分别为 8.77 和 7.68 QALYs）。计算出的增量成本效益比为负，表明 PM 是一种经济上占主导地位的策略。这些结果在单因素和概率敏感性分析中是稳健的。
结论
与 SOC 相比，PM 具有经济性优势，预计可节省成本。
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