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| BRCA1 或BRCA2突变妇女预防策略的费用效益比 |
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| Cost-Effectiveness of Preventive Strategies for Women with a BRCA1 or a BRCA2 Mutation |
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| Anderson K, Jacobson JS, Heitjan DF 2009/5/27 10:50:40 |
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| Ann Intern Med, 2006, |
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| View at Publisher |
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Abstract
Background:
For BRCA1 or BRCA2 mutation carriers, decision analysis indicates that prophylactic surgery or chemoprevention leads to better survival than surveillance alone.
Objective:
To evaluate the cost-effectiveness of the preventive strategies that are available to unaffected women carrying a single BRCA1 or BRCA2 mutation with high cancer penetrance.
Design:
Markov modeling with Monte Carlo simulations and probabilistic sensitivity analyses.
Data Sources:
Breast and ovarian cancer incidence and mortality rates, preference ratings, and costs derived from the literature; the Surveillance, Epidemiology, and End Results (SEER) Program; and the Health Care Financing Administration (now the Centers for Medicare & Medicaid Services).
Target Population:
Unaffected carriers of a single BRCA1 or BRCA2 mutation 35 to 50 years of age.
Time Horizon:
Lifetime.
Perspective:
Health policy, societal.
Interventions:
Tamoxifen, oral contraceptives, bilateral salpingo-oophorectomy, mastectomy, both surgeries, or surveillance.
Outcome Measures:
Cost-effectiveness.
Results of Base-Case Analysis:
For mutation carriers 35 years of age, both surgeries (prophylactic bilateral mastectomy and oophorectomy) had an incremental cost-effectiveness ratio over oophorectomy alone of $2352 per life-year for BRCA1 and $100 per life-year for BRCA2. With quality adjustment, oophorectomy dominated all other strategies for BRCA1 and had an incremental cost-effectiveness ratio of $2281 per life-year for BRCA2.
Results of Sensitivity Analysis:
Older age at intervention increased the cost-effectiveness of prophylactic mastectomy for BRCA1 mutation carriers to $73 755 per life-year. Varying the penetrance, mortality rates, costs, discount rates, and preferences had minimal effects on outcomes (Table 4).
Limitations:
Results are dependent on the accuracy of model assumptions.
Conclusion:
On the basis of this model, the most cost-effective strategies for BRCA mutation carriers, with and without quality adjustment, were oophorectomy alone and oophorectomy and mastectomy, respectively. |
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 疾病资源中心
病例分析 [栏目介绍]
王燕燕 王曙
上海交通大学附属瑞金医院内分泌科
患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
医学数据库
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