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A bronchial-airway gene-expression classifier to improve the diagnosis of lung cancer: Clinical outcomes and cost-effectiveness analysis.

提高肺癌诊断的支气管-气道基因表达分类器: 临床结果和成本效益分析。

  • 影响因子:6.93
  • DOI:10.1002/ijc.32333
  • 作者列表:"D'Andrea E","Choudhry NK","Raby B","Weinhouse GL","Najafzadeh M
  • 发表时间:2020-02-01
Abstract

:Bronchoscopy is the safest procedure for lung cancer diagnosis when an invasive evaluation is required after imaging procedures. However, its sensitivity is relatively low, especially for small and peripheral lesions. We assessed benefits and costs of introducing a bronchial gene-expression classifier (BGC) to improve the performance of bronchoscopy and the overall diagnostic process for early detection of lung cancer. We used discrete-event simulation to compare clinical and economic outcomes of two different strategies with the standard practice in former and current smokers with indeterminate nodules: (i) location-based strategy-integrated the BGC to the bronchoscopy indication; (ii) simplified strategy-extended use of bronchoscopy plus BGC also on small and peripheral lesions. Outcomes modeled were rate of invasive procedures, quality-adjusted-life-years (QALYs), costs and incremental cost-effectiveness ratios. Compared to the standard practice, the location-based strategy (i) reduced absolute rate of invasive procedures by 3.3% without increasing costs at the current BGC market price. It resulted in savings when the BGC price was less than $3,000. The simplified strategy (ii) reduced absolute rate of invasive procedures by 10% and improved quality-adjusted life expectancy, producing an incremental cost-effectiveness ratio of $10,109 per QALY. In patients with indeterminate nodules, both BGC strategies reduced unnecessary invasive procedures at high risk of adverse events. Moreover, compared to the standard practice, the simplified use of BGC for central and peripheral lesions resulted in larger QALYs gains at acceptable cost. The location-based is cost-saving if the price of classifier declines.

摘要

: 当成像程序后需要侵入性评估时,支气管镜检查是肺癌诊断的最安全程序。然而,其敏感性相对较低,尤其是对于小的和外周病变。我们评估了引入支气管基因表达分类器 (BGC) 的益处和成本,以改善支气管镜检查的性能和肺癌早期检测的整体诊断过程。我们使用离散事件模拟来比较两种不同策略的临床和经济结果,以及在患有不确定结节的前吸烟者和当前吸烟者中的标准做法 :( i) 基于位置的策略-将BGC整合到支气管镜检查适应症; (ii) 简化策略-支气管镜检查加BGC也在小病灶和外周病变上的扩展使用。结果建模为侵入性操作率、质量调整生命年 (QALYs) 、成本和增量成本效益比.与标准实践相比,基于位置的策略 (i) 以当前BGC市场价格在不增加成本的情况下将侵入性操作的绝对速率降低了 3.3%。当BGC价格低于 3,000 美元时,它导致了节约。简化策略 (ii) 将侵入性操作的绝对发生率降低了 10%,并提高了质量调整后的预期寿命,产生了每QALY 10,109 美元的增量成本效益比。在具有不确定结节的患者中,两种BGC策略都减少了不必要的侵入性操作,具有高风险的不良事件。此外,与标准实践相比,BGC用于中心和外周病变的简化使用在可接受的成本下导致更大的QALYs增益。如果分类器的价格下降,基于位置的是节省成本的。

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DOI:10.1002/ijc.32532
作者列表:["Hata A","Nakajima T","Matsusaka K","Fukuyo M","Morimoto J","Yamamoto T","Sakairi Y","Rahmutulla B","Ota S","Wada H","Suzuki H","Matsubara H","Yoshino I","Kaneda A"]

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DOI:10.1002/ijc.32530
作者列表:["Zhang L","Yang Y","Chai L","Bu H","Yang Y","Huang H","Ran J","Zhu Y","Li L","Chen F","Li W"]

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肺肿瘤方向

肺肿瘤,又叫支气管肺癌,是常见的恶性肿瘤之一。肺肿瘤的治疗为包括手术、中药、放疗、化疗及免疫等多学科的综合治疗。

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