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Đánh giá kinh tế của xét nghiệm di truyền dòng germline cho ung thư vú ở các quốc gia có thu nhập thấp và trung bình: một đánh giá hệ thống
BMC Cancer - 2024
Tóm tắt
Ung thư vú (BC) là loại ung thư phổ biến nhất ảnh hưởng đến phụ nữ toàn cầu. Xét nghiệm di truyền đóng vai trò là một chiến lược phòng ngừa và điều trị để quản lý ung thư vú. Nghiên cứu này nhằm mục đích tổng hợp hệ thống các đánh giá kinh tế và chất lượng của các nghiên cứu được chọn liên quan đến các chiến lược sàng lọc di truyền cho ung thư vú ở các quốc gia có thu nhập thấp và trung bình (LMICs). Một cuộc tìm kiếm đã được thực hiện để xác định các bài báo liên quan đã được công bố đến tháng 4 năm 2023 trên PubMed, Embase, CINAHL, Web of Science và Trung tâm Đánh giá và Phổ biến thông tin. Chỉ những nghiên cứu về LMIC bằng tiếng Anh mới được đưa vào. Tổng hợp các đặc điểm của các nghiên cứu, sự khác biệt về phương pháp và dữ liệu đầu vào, tỷ lệ chi phí - hiệu quả gia tăng (ICERs) và chất lượng báo cáo (Danh sách kiểm tra các tiêu chuẩn báo cáo đánh giá kinh tế sức khỏe hợp nhất (CHEERS) 2022) đã được thực hiện. Đánh giá này đã tìm thấy năm nghiên cứu liên quan, chủ yếu tập trung vào các đánh giá kinh tế của xét nghiệm di truyền dòng germline ở các quốc gia có thu nhập trung bình - cao (Upper MICs) như Malaysia, Trung Quốc và Brazil. Chỉ có một nghiên cứu bao gồm nhiều quốc gia với mức thu nhập khác nhau, bao gồm các quốc gia có thu nhập trung bình thấp (Lower MICs) như Ấn Độ. Giá trị ICER trong nhiều kịch bản sàng lọc cho ung thư vú giai đoạn sớm, bệnh nhân BC HER2 âm tính và phụ nữ khỏe mạnh có tiêu chí lâm sàng hoặc tiền sử gia đình dao động từ 2214 USD/QALY đến 36,342 USD/QALY. Xét nghiệm đa gen cho tất cả bệnh nhân ung thư vú với xét nghiệm chuỗi có giá là 7729 USD/QALY so với xét nghiệm BRCA một mình. Hầu hết các nghiên cứu đều tuân thủ các tiêu chí CHEERS 2022, cho thấy chất lượng phương pháp cao. Xét nghiệm dòng germline có thể được coi là hiệu quả về chi phí so với không xét nghiệm ở các quốc gia Upper MIC (ví dụ: Malaysia, Trung Quốc, Brazil) nhưng không ở các quốc gia Lower MIC (ví dụ: Ấn Độ) dựa trên ngưỡng sẵn sàng chi trả (WTP) được thiết lập bởi từng nghiên cứu tương ứng. Các hạn chế ngăn cản việc đưa ra kết luận chắc chắn về tính hiệu quả chi phí trên toàn LMIC. Nhiều nghiên cứu có chất lượng cao hơn là rất quan trọng để đưa ra quyết định thông minh và cải thiện các thực hành chăm sóc sức khỏe ở các khu vực này.
Từ khóa
#ung thư vú #xét nghiệm di truyền #đánh giá kinh tế #quốc gia có thu nhập thấp và trung bình #hiệu quả chi phíTài liệu tham khảo
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