期刊
JOURNAL OF CLINICAL ONCOLOGY
卷 38, 期 33, 页码 -出版社
AMER SOC CLINICAL ONCOLOGY
DOI: 10.1200/JCO.20.00418
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资金
- National Institutes of Health [P30CA21765, U24CA55727, U01CA195547]
- American Cancer Society [RSG-16018-01-CPHPS]
- American Lebanese Syrian Associated Charities
PURPOSESurvivors of childhood cancer treated with anthracyclines and/or chest-directed radiation are at increased risk for heart failure (HF). The International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) recommends risk-based screening echocardiograms, but evidence supporting its frequency and cost-effectiveness is limited.PATIENTS AND METHODSUsing the Childhood Cancer Survivor Study and St Jude Lifetime Cohort, we developed a microsimulation model of the clinical course of HF. We estimated long-term health outcomes and economic impact of screening according to IGHG-defined risk groups (low [doxorubicin-equivalent anthracycline dose of 1-99 mg/m(2) and/or radiotherapy < 15 Gy], moderate [100 to < 250 mg/m(2) or 15 to < 35 Gy], or high [ 250 mg/m(2) or >= 35 Gy or both >= 100 mg/m(2) and >= 15 Gy]). We compared 1-, 2-, 5-, and 10-year interval-based screening with no screening. Screening performance and treatment effectiveness were estimated based on published studies. Costs and quality-of-life weights were based on national averages and published reports. Outcomes included lifetime HF risk, quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs). Strategies with ICERs < $100,000 per QALY gained were considered cost-effective.RESULTSAmong the IGHG risk groups, cumulative lifetime risks of HF without screening were 36.7% (high risk), 24.7% (moderate risk), and 16.9% (low risk). Routine screening reduced this risk by 4% to 11%, depending on frequency. Screening every 2, 5, and 10 years was cost-effective for high-risk survivors, and every 5 and 10 years for moderate-risk survivors. In contrast, ICERs were > $175,000 per QALY gained for all strategies for low-risk survivors, representing approximately 40% of those for whom screening is currently recommended.CONCLUSIONOur findings suggest that refinement of recommended screening strategies for IGHG high- and low-risk survivors is needed, including careful reconsideration of discontinuing asymptomatic left ventricular dysfunction and HF screening in low-risk survivors.
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