Barosi G, Marchetti M, Dazzi L, Quaglini S
IRCCS Policlinico S. Matteo and Department of Computer Science and Systems, University of Pavia, Italy.
Thromb Haemost. 1997 Nov;78(5):1319-26.
To determine the effectiveness and cost-effectiveness of testing for occult cancer in idiopathic deep vein thrombosis (IDVT).
Threshold analysis was performed on the risk-adjusted cancer prevalence in a cost-effectiveness model of ideal testing for selecting cancers with potentially desirable utility (candidate cancers). Decision analysis was employed to compare different testing programs for candidate cancers with that of no testing. Life expectancy (LE) of early- and late-detected cancers and costs of testing were the dimensions of utility. Cost-effectiveness was expressed as marginal cost per year of life saved. The perspective of the third payer was adopted, and a discount rate of 3% was applied to both costs and benefits.
Risk of cancer in IDVT, testing policies, test characteristics, and LE were gathered from literature. Costs were provided from our hospital rate book and accounting service.
Ideal testing would support a gain of LE of 40 days or more for prostate, colon and bladder cancer in males and for colon, breast and endometrium cancer in females aged from 60 to 69 years. Testing females with colonoscopy and mammography in any sequence provides 70 days of life gained. Testing males with colonoscopy provides 27 days of life gained. Lower and older ages reduce testing effectiveness. The qualitative results are stable over plausible ranges of test characteristics, while variations in the value of benefit for early cancer diagnosis may modify the strategy. Incremental cost-effectiveness ranges from $1,789 to $ 6,979 per year of life gained.
According to the effectiveness criterion adopted, the only worthwhile investigation strategy includes colon and breast cancer in females. Testing for colon cancer in males is desirable at a lower criterion of effectiveness. All the strategies are cost effective.
确定特发性深静脉血栓形成（IDVT）患者隐匿性癌症检测的有效性和成本效益。
在一个成本效益模型中，对风险调整后的癌症患病率进行阈值分析，该模型用于对具有潜在理想效用的癌症（候选癌症）进行理想检测。采用决策分析将候选癌症的不同检测方案与不进行检测的方案进行比较。早期和晚期检测到的癌症的预期寿命（LE）以及检测成本是效用的维度。成本效益表示为每挽救一年生命的边际成本。采用第三方支付者的视角，对成本和效益均应用3%的贴现率。
从文献中收集IDVT患者的癌症风险、检测策略、检测特征和预期寿命。成本由我院收费手册和会计服务提供。
理想检测将使60至69岁男性的前列腺癌、结肠癌和膀胱癌以及女性的结肠癌、乳腺癌和子宫内膜癌的预期寿命增加40天或更多。以任何顺序对女性进行结肠镜检查和乳房X线摄影可使预期寿命增加70天。对男性进行结肠镜检查可使预期寿命增加27天。年龄越低和越大，检测效果越低。在合理的检测特征范围内，定性结果是稳定的，而早期癌症诊断效益值的变化可能会改变策略。每增加一年生命的增量成本效益范围为1789美元至6979美元。
根据所采用的有效性标准，唯一值得采用的检测策略包括对女性进行结肠癌和乳腺癌检测。在较低的有效性标准下，对男性进行结肠癌检测是可取的。所有策略均具有成本效益。
