Mooney M M, Mettlin C, Michalek A M, Petrelli N J, Kraybill W G
Division of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, New York 14263-0001, USA.
Cancer. 1997 Sep 15;80(6):1052-64. doi: 10.1002/(sici)1097-0142(19970915)80:6<1052::aid-cncr7>3.0.co;2-b.
Costs and potential benefits of an intensive chest X-ray (CXR) screening program to detect asymptomatic pulmonary metastases in patients with intermediate-thickness, local, cutaneous melanoma were assessed.
Cost-effectiveness analysis from a societal perspective was performed using data on recurrence detection from an historic cohort at Roswell Park Cancer Institute and other published studies, estimates of new cases of melanoma in 1996 from the National Cancer Institute's Surveillance, Epidemiology, and End Results program, and estimates of cost and treatment benefits from published articles retrieved through MEDLINE. Net costs were calculated as the added cost of CXR screening to regular follow-up and the costs incurred in the surgical treatment of lung recurrences. Net benefits were calculated as potential savings in nonquality-adjusted life years (NQALY) and quality-adjusted life years (QALY) resulting from surgical treatment. Cost-effectiveness ratios were calculated as the present value of net costs divided by net benefits, with benefits presented in discounted and undiscounted forms.
For the base case, cost of screening per NQALY was $150,000 and was $165,000 for QALY in 1996 dollars using undiscounted health benefits. Screening accounted for approximately 80% of program costs and treatment accounted for 20%. Annual cost-effectiveness ratios were lowest in Years 3-10 of screening. The total cost of a 20-year screening program for patients diagnosed in 1996 was estimated to be between $27-$32 million.
Even in the absence of certain benefits, the model demonstrates that significant cost savings may be possible by decreasing screening frequency in the first 2 years and limiting screening to the first 5-10 years after diagnosis.
评估了一项强化胸部X线（CXR）筛查计划用于检测中度厚度、局部皮肤黑色素瘤患者无症状肺转移的成本和潜在益处。
从社会角度进行成本效益分析，使用罗斯韦尔帕克癌症研究所历史队列的复发检测数据及其他已发表研究、美国国立癌症研究所监测、流行病学和最终结果计划中1996年黑色素瘤新发病例的估计数，以及通过MEDLINE检索到的已发表文章中的成本和治疗益处估计数。净成本计算为CXR筛查相对于常规随访增加的成本以及肺复发手术治疗产生的成本。净效益计算为手术治疗带来的非质量调整生命年（NQALY）和质量调整生命年（QALY）的潜在节省。成本效益比计算为净成本的现值除以净效益，效益以贴现和未贴现形式呈现。
对于基础病例，使用未贴现的健康效益，每NQALY的筛查成本为150,000美元，每QALY为165,000美元（按1996年美元计算）。筛查约占项目成本的80%，治疗占20%。筛查第3 - 10年的年度成本效益比最低。1996年诊断患者的20年筛查计划总成本估计在2700万 - 3200万美元之间。
即使没有某些益处，该模型表明，通过在前2年降低筛查频率并将筛查限制在诊断后的前5 - 10年，可能实现显著的成本节省。
