School of Public Health, Sun Yat-Sen University, Guangzhou, China.
State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China.
Front Public Health. 2024 May 2;12:1375533. doi: 10.3389/fpubh.2024.1375533. eCollection 2024.
Nasopharyngeal carcinoma (NPC) has an extremely high incidence rate in Southern China, resulting in a severe disease burden for the local population. Current EBV serologic screening is limited by false positives, and there is opportunity to integrate polygenic risk scores for personalized screening which may enhance cost-effectiveness and resource utilization.
A Markov model was developed based on epidemiological and genetic data specific to endemic areas of China, and further compared polygenic risk-stratified screening [subjects with a 10-year absolute risk (AR) greater than a threshold risk underwent EBV serological screening] to age-based screening (EBV serological screening for all subjects). For each initial screening age (30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, and 65-69 years), a modeled cohort of 100,000 participants was screened until age 69, and then followed until age 79.
Among subjects aged 30 to 54 years, polygenic risk-stratified screening strategies were more cost-effective than age-based screening strategies, and almost comprised the cost-effectiveness efficiency frontier. For men, screening strategies with a 1-year frequency and a 10-year absolute risk (AR) threshold of 0.7% or higher were cost-effective, with an incremental cost-effectiveness ratio (ICER) below the willingness to pay (¥203,810, twice the local GDP). Specifically, the strategies with a 10-year AR threshold of 0.7% or 0.8% are the most cost-effective strategies, with an ICER ranging from ¥159,752 to ¥201,738 compared to lower-cost non-dominated strategies on the cost-effectiveness frontiers. The optimal strategies have a higher probability (29.4-35.8%) of being cost-effective compared to other strategies on the frontier. Additionally, they reduce the need for nasopharyngoscopies by 5.1-27.7% compared to optimal age-based strategies. Likewise, for women aged 30-54 years, the optimal strategy with a 0.3% threshold showed similar results. Among subjects aged 55 to 69 years, age-based screening strategies were more cost-effective for men, while no screening may be preferred for women.
Our economic evaluation found that the polygenic risk-stratified screening could improve the cost-effectiveness among individuals aged 30-54, providing valuable guidance for NPC prevention and control policies in endemic areas of China.
鼻咽癌（NPC）在中国南方地区发病率极高，给当地居民带来了沉重的疾病负担。目前的 EBV 血清学筛查受到假阳性的限制，有机会整合多基因风险评分进行个性化筛查，这可能会提高成本效益和资源利用效率。
根据中国流行地区的流行病学和遗传数据，建立了马尔可夫模型，并进一步比较了多基因风险分层筛查[10 年绝对风险（AR）大于阈值风险的受试者进行 EBV 血清学筛查]与年龄筛查（所有受试者进行 EBV 血清学筛查）。对于每个初始筛查年龄（30-34、35-39、40-44、45-49、50-54、55-59、60-64 和 65-69 岁），对 100,000 名参与者进行了模型队列筛查，直至 69 岁，然后继续随访至 79 岁。
在 30 至 54 岁的受试者中，多基因风险分层筛查策略比年龄筛查策略更具成本效益，几乎构成了成本效益效率边界。对于男性，筛查策略的频率为 1 年，10 年 AR 阈值为 0.7%或更高，则具有成本效益，增量成本效益比（ICER）低于意愿支付（¥203,810，是当地 GDP 的两倍）。具体来说，10 年 AR 阈值为 0.7%或 0.8%的策略是最具成本效益的策略，与成本效益边界上成本较低的非主导策略相比，ICER 范围在¥159,752 至 ¥201,738 之间。与边界上的其他策略相比，最优策略具有更高的（29.4-35.8%）成本效益可能性。此外，与最优年龄筛查策略相比，它们减少了 5.1-27.7%的鼻咽镜检查需求。同样，对于 30-54 岁的女性，0.3%阈值的最优策略也显示出类似的结果。对于 55 至 69 岁的受试者，年龄筛查策略对男性更具成本效益，而女性可能不需要进行筛查。
我们的经济评估发现，多基因风险分层筛查可以提高 30-54 岁人群的成本效益，为中国流行地区 NPC 预防控制政策提供了有价值的指导。
