大腸直腸癌:混合篩檢更有效、花費更少


  【24drs.com】根據一篇模擬模型,50歲開始每年或每2年進行糞便免疫學試驗(FIT),加上在66歲時進行一次大腸鏡檢查,和目前的大腸直腸癌(CRC)篩檢指引一樣有效;再者,混合篩檢策略所需的資源比目前的CRC篩檢規範少;這些研究結果和最近的美國預防服務工作小組的分析一致。
  
  加州舊金山Archimedes公司的Tuan Dinh博士等人在9月的臨床腸胃病學與肝臟病學期刊發表這篇成本效益分析。
  
  在這篇文章中,他們解釋,我們使用阿基米得模式比較混合型CRC篩檢策略的成本效益,在30年期間,較年輕組(50–65歲)每年一次FIT且在66歲時進行一次大腸鏡檢查,[Kaiser Permanente Northern California]的代表組進行其他篩檢策略。這類策略可以改善較年輕病患的順從性,可減少較年長者的大腸鏡檢查併發症總數。
  
  作者們比較了每年一次FIT這個單一方式篩檢、每5年進行乙狀結腸鏡檢查、每10年進行大腸鏡檢查等混合型篩檢策略;他們也考量了混合型篩檢策略,包括50-65歲病患每年一次FIT,然後在66歲時進行一次大腸鏡檢查(FIT/COLOx1)。
  
  他們發現,相較於沒有篩檢,所有的評估篩檢策略都可改善結果,減少CRC的花費;作者們承認,模型預測之準確性端賴於檢測表現的假設。
  
  他們報告指出,篩檢間隔從1年改為2年的這項改變,並未顯著降低混合篩檢的效益;不過,66歲時進行大腸鏡檢查的遵從性是保持混合篩檢計畫之效果的關鍵。
  
  傳統上,使用FIT的門檻是血紅素(Hb)100 ng /mL,但是作者們認為,門檻訂為50 ng Hb/mL或許比較適當。
  
  作者們寫道,我們從有限的資料分析估計FIT在50 ng Hb/mL時的敏感性和專一性。50 ng Hb/mL時使用FIT增加了敏感性但降低了專一性,使得中度增加品質調整生命年數且節省了FIT/COLOx1的費用。最有趣的是,在健康效益和費用方面,50 ng Hb/mL時進行FIT/COLOx1的篩檢效益優於大腸鏡檢查。
  
  相較於只有進行大腸鏡檢查者,FIT/COLOx1減少了37%的大腸鏡檢查數,健康效益方面差不多;混合篩檢方式的成本效益,可歸因於FIT的費用相對較低。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=7008&x_classno=0&x_chkdelpoint=Y
  

Colorectal Cancer: Hybrid Screening Effective, Less Costly

By Lara C. Pullen, PhD
Medscape Medical News

An annual or biennial fecal immunological test (FIT) beginning at age 50 years in combination with a single colonoscopy at age 66 years is as effective as current colorectal cancer (CRC) screening guidelines, according to a simulation model. Moreover, the hybrid screening strategy requires fewer resources than the current CRC screening protocol. The findings are consistent with a recent US Preventive Services Task Force analysis.

Tuan Dinh, PhD, from Archimedes Inc, San Francisco, California, and colleagues published the results of their cost-effectiveness analysis in the September issue of Clinical Gastroenterology and Hepatology.

In the article, they explain, "we used the Archimedes Model to compare the cost-effectiveness of a hybrid CRC screening strategy, by using annual FIT at younger ages (50–65 years) combined with a single colonoscopy at age 66, against other screening strategies in a population representative of [Kaiser Permanente Northern California] members during a 30-year period. Such a strategy has the potential to improve compliance at younger ages and may reduce the total number of colonoscopy complications at older ages."

The authors compared the hybrid screening strategy with single-modality screening using annual FIT, sigmoidoscopy every 5 years, and colonoscopy every 10 years. They also considered hybrid screening strategies, including annual FIT of patients aged 50 to 65 years and then a single colonoscopy at age 66 years (FIT/COLOx1).

They found that all of the evaluated screening strategies improved outcomes and reduced the costs of CRC compared with no screening. The authors acknowledge that the accuracy of the model prediction is dependent on assumptions about test performance.

They report that a change in the screening interval from 1 to 2 years did not significantly reduce the benefits of hybrid screening. However, adherence to colonoscopy at age 66 years was critical to maintaining the effectiveness of the hybrid screening program.

Traditionally, FIT uses a cutoff threshold of 100 ng hemoglobin (Hb)/mL, but the authors suggest a threshold of 50 ng Hb/mL may be optimal.

"We estimated the sensitivity and specificity of FIT with a 50 ng Hb/mL cutoff from limited data available at the time of the analysis. Increasing the sensitivity and decreasing the specificity of FIT by using a 50 ng Hb/mL cutoff led to modest increases in the [quality-adjusted life-years] gains and cost savings of FIT/COLOx1. Most interestingly, FIT/COLOx1 that used a 50 ng Hb/mL cutoff outperformed screening by colonoscopy in both health benefits and costs," the authors write.

FIT/COLOx1 resulted in 37% fewer colonoscopies than colonoscopy alone and delivered only slightly inferior health benefits. The cost effectiveness of the hybrid screening approach is the result of the relatively low cost of FIT.

The authors have disclosed no relevant financial relationships.

Clin Gastroenterol Hepatol. 2013;11:1158-1166.

    
相關報導
體適能較佳與某些癌症及死亡風險較低有關
2015/4/15 上午 10:28:31
紅肉與癌症:還有未知機轉?
2015/1/15 上午 10:19:15
年長者進行大腸癌篩檢具有成本效益
2014/6/5 上午 11:34:41

上一頁
   1   2   3   4   5   6   7   8   9   10  




回上一頁