Cancer Epidemiology Research Programme, Catalan Institute of Oncology. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain.
Bellvitge Biomedical Research Institute-IDIBELL. Av Gran Vía 199-203, 08908L'Hospitalet de Llobregat, Barcelona, Spain.
Br J Cancer. 2023 Aug;129(2):325-334. doi: 10.1038/s41416-023-02291-1. Epub 2023 May 10.
New approaches are being developed to early detect endometrial cancer using molecular biomarkers. These approaches offer high sensitivities and specificities, representing a promising horizon to develop early detection strategies.
To evaluate the effectiveness and cost-effectiveness of introducing molecular testing to detect endometrial cancer in women with postmenopausal bleeding compared to the current strategy using the national healthcare service perspective.
A Markov model was developed to assess the two early detection strategies. The model predicts the number of hysterectomies, lifetime expectancy, quality-adjusted life-years, endometrial cancer prevalence and incidence, mortality from endometrial cancer and the lifetime cost of screening, diagnosis, and treatment. Strategies were compared using the incremental cost-effectiveness ratio.
The molecular strategy reduces 1.9% of the overall number of hysterectomies and the number of undetected cancer cases by 65%. Assuming a molecular test cost of 310€, the molecular strategy has an incremental cost of -32,952€ per QALY gained, being more effective and less expensive than the current strategy.
The introduction of molecular testing to diagnose endometrial cancer in women presenting postmenopausal bleeding provides more health benefit at a lower cost, and therefore has the potential to be cost-effective.
目前正在开发新的方法，通过分子生物标志物来早期检测子宫内膜癌。这些方法具有较高的灵敏度和特异性，为开发早期检测策略提供了广阔的前景。
从国家医疗保健服务的角度出发，评估与当前策略相比，将分子检测引入绝经后出血女性子宫内膜癌检测中的有效性和成本效益。
我们开发了一个马尔可夫模型来评估两种早期检测策略。该模型预测了子宫切除术的数量、预期寿命、质量调整生命年、子宫内膜癌的患病率和发病率、子宫内膜癌死亡率以及筛查、诊断和治疗的终身成本。通过增量成本效益比来比较策略。
分子策略减少了 1.9%的总体子宫切除术数量和 65%的未检测到的癌症病例。假设分子检测的成本为 310 欧元，那么分子策略每获得一个质量调整生命年的增量成本为-32952 欧元，比现行策略更有效且更便宜。
将分子检测引入绝经后出血女性的子宫内膜癌诊断中，可以提供更多的健康效益，同时降低成本，因此具有成本效益的潜力。
