英国补偿性肝硬化患者 HCC 监控策略的成本效益。

IF 4.9 2区医学 Q1 ECONOMICS

Value in Health Pub Date : 2024-12-01 DOI:10.1016/j.jval.2024.07.015

Osvaldo Ulises Garay MSc , Louisa Elena Ambühl MSc , Thomas G. Bird MD , Eleanor Barnes MD , William L. Irving MD , Ryan Walkley MSc , Ian A. Rowe MD

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引用次数: 0

摘要

研究目的本研究旨在评估英国四种肝细胞癌（HCC）监测策略的成本效益（CE），即GAAD算法（将性别（生物学性别）和年龄与Elecsys®生物标志物检测、甲胎蛋白（AFP）和维生素K缺失诱导蛋白-II（PIVKA-II）相结合）、超声波（US）、US+AFP和GAAD+US：方法：从英国国民健康服务的角度出发，在 Microsoft Excel® 中开发了一个全新的微观模拟状态转换马尔可夫模型，用于计算生命年、质量调整生命年 (QALY)、成本、增量 CE 比率和净货币收益。参数来源于同行评审发表的文献、国家指南和公共成本数据库。进行了敏感性和情景分析，以评估参数和结构不确定性对结果的影响：在 10 万名患者的模拟队列中，US 的每位患者贴现成本和 QALY 分别为 8,663 英镑和 6-066 英镑，US+AFP 分别为 9,095 英镑和 6-076，GAAD 单独为 8,719 英镑和 6-078，GAAD+US 分别为 9,114 英镑和 6-086。在 20,000 英镑/QALY 的 CE 临界值下，GAAD 是最具成本效益的策略；然而，尽管成本最高，但 GAAD+US 的临床效果最好。敏感性和情景分析表明，HCC发病率以及与诊断效果相关的成本会影响CE：考虑到 US 的成本和英国 HCC 的低发病率，本研究表明，与 US 和 US+AFP 相比，GAAD 单独使用或与 US 结合使用都是具有成本效益的监测策略。虽然 GAAD+US 的 QALY 增长率最高，但就 CE 而言，单独使用 GAAD 更为可取；不过，还需要对 GAAD+US 的性能进行更好的估算才能确认。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Cost-Effectiveness of Hepatocellular Carcinoma Surveillance Strategies in Patients With Compensated Liver Cirrhosis in the United Kingdom

Objectives

This study aimed to evaluate the cost-effectiveness (CE) of 4 hepatocellular carcinoma (HCC) surveillance strategies in the United Kingdom, the GAAD algorithm, which combines Gender (biological sex) and Age with Elecsys® biomarker assays, alpha-fetoprotein (AFP) and protein induced by vitamin K absence-II (previously Des-γ-carboxy prothrombin); ultrasound (US); US + AFP and GAAD + US.

Methods

A de novo microsimulation state-transition Markov model was developed in Microsoft Excel® from the perspective of the United Kingdom National Health Service to calculate life-years, quality-adjusted life-years (QALYs), costs, incremental CE ratios, and net monetary benefits. Parameters were sourced from peer-reviewed published literature, national guidelines, and public cost databases. Sensitivity and scenario analyses were performed to evaluate the impact of parameter and structural uncertainty on the results.

Results

In a simulated cohort of 100 000 patients, discounted costs and QALYs per patient were £8663 and 6·066 for US, £9095 and 6·076 for US + AFP, £8719 and 6·078 for GAAD alone, and £9114 and 6·086 for GAAD + US. At a CE threshold of £20 000/QALY, GAAD was the most cost-effective strategy; however, although most costly, GAAD + US was the most clinically effective. Sensitivity and scenario analyses indicated that HCC incidence along with costs associated with diagnostic performance influence CE.

Conclusion

Considering the cost of US and low incidence of HCC in the United Kingdom, this study suggests that GAAD alone or in combination with US are cost-effective surveillance strategies compared with US and US + AFP. Although GAAD + US showed the highest QALY increase, GAAD alone is considered preferable regarding CE; however, better performance estimates for GAAD + US are needed to confirm.

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来源期刊

Value in Health 医学-卫生保健

CiteScore

6.90

自引率

6.70%

发文量

3064

审稿时长

3-8 weeks

期刊介绍： Value in Health contains original research articles for pharmacoeconomics, health economics, and outcomes research (clinical, economic, and patient-reported outcomes/preference-based research), as well as conceptual and health policy articles that provide valuable information for health care decision-makers as well as the research community. As the official journal of ISPOR, Value in Health provides a forum for researchers, as well as health care decision-makers to translate outcomes research into health care decisions.