乳腺癌多基因面板测序的成本效果分析

摘要

Objective:To model and evaluate the cost-effectiveness of next-generation sequencing(NGS)panel for the screening of breast and ovarian cancer using the decision-making model amongst UK Ashkenazi Jews(AJ) women in the German community,determining whether a multi-gene panel would be cost-effective in patients referred to high-risk of breast cancer when compared with no testing program.Methods:Based on the population epidemiology and cost data in the United Kingdom,a decision-analytic model was developed to compare lifetime costs and benefits associated with NGS panel.The cost-effectiveness analysis was analyzed from a payer,s perspective across a lifetime horizon.Multiple source data were used for estimating cancer incidence,total costs,life-years,quality-adjusted life-years(QALYs)and incremental cost-effectiveness ratio(ICER).Costs were reported at 2014 prices and discounted at 3.5%.Deterministic and probabilistic sensitivity analysis(PSA)based on Monte Carlo Simulations were per-formed to evaluate the robustness of model.Results:In the base-case analysis,compared with no screening strategy, multi-gene panel test lowered the cancer incidence by 1.1%(0.75% for breast cancer,0.47% for ovarian canc-er),and gained an additional 0.87 life years and 0.89 QALYs,resulting in a discounted ICER of? 6766/QALY. Considering 70%testing uptake,this led to 601 fewer breast cancer cases and 283 fewer ovarian cancer cases.One-way sensitivity analysis indicated that the model was robust to variations for most of model parameters.The penetrance rate of breast cancer susceptibility genes was an important factor affecting overall results of the model.PSA showed that the probability for NGS panel being cost-effective at the threshold of? 20000/QALY-￡ 30000/QALY was over than 90%,compared with no screening strategy.Conclusion: NGS panel testing of breast cancer was cost-effective compared with no screening strategy,especially for those AJ women with high mutation rates.%目的:以英国德系犹太妇女人群为背景,用决策模型评估多基因面板检测在乳腺癌与卵巢癌筛检上的成本效果.方法:结合英国人口流行病及成本数据,建立决策树模型,基于付费者的角度,从多个文献中获取相关概率和成本数据,进行成本效果分析.成本以2014年价格为基准,采用3.5%的贴现率进行贴现.通过单因素敏感性分析和概率敏感性分析测试模型的稳健性.结果:与无基因检测相比,多基因面板检测降低了1.1%的癌症发生率,挽救了601例乳腺癌和283例卵巢癌患者,延长了0.87个生命年和0.89个质量调整生命年,增量成本效果比为￡ 6766/QALY.敏感性分析显示模型稳健性较好,乳腺癌易感基因突变率是影响模型的重要因素.在￡ 20000/QALY~￡ 30000/QALY的阈值范围内多基因检测有90%以上的概率具有成本效果.结论:与无基因检测相比,乳腺癌二代面板测序在突变率较高的英国德系犹太妇女人群中具有成本效果.