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Liquid biopsy posttreatment surveillance in endemic nasopharyngeal carcinoma: a cost-effective strategy to integrate circulating cell-free Epstein-Barr virus DNA
- Source :
- BMC Medicine, Vol 19, Iss 1, Pp 1-13 (2021), BMC Medicine
- Publication Year :
- 2021
- Publisher :
- BMC, 2021.
-
Abstract
- Background The optimal posttreatment surveillance strategy for nasopharyngeal carcinoma (NPC) remains unclear. Circulating cell-free Epstein-Barr virus (cfEBV) DNA has been recognized as a promising biomarker to facilitate early detection of NPC recurrence. Therefore, we aim to determine whether integrating circulating cfEBV DNA into NPC follow-up is cost-effective. Methods For each stage of asymptomatic nonmetastatic NPC patients after complete remission to primary NPC treatment, we developed a Markov model to compare the cost-effectiveness of the following surveillance strategies: routine follow-up strategy, i.e., (1) routine clinical physical examination; routine imaging strategies, including (2) routine magnetic resonance imaging plus computed tomography plus bone scintigraphy (MRI + CT + BS); and (3) routine 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT); cfEBV DNA-guided imaging strategies, including (4) cfEBV DNA-guided MRI + CT + BS and (5) cfEBV DNA-guided PET/CT. Clinical probabilities, utilities, and costs were derived from published studies or databases. Sensitivity analyses were performed. Results For all disease stages, cfEBV DNA-guided imaging strategies demonstrated similar survival benefits but were considerably more economical than routine imaging strategies. They only required approximately one quarter of the number of imaging studies compared with routine imaging strategies to detect one recurrence. Specifically, cfEBV DNA-guided MRI + CT + BS was most cost-effective for stage II (incremental cost-effectiveness ratio [ICER] $57,308/quality-adjusted life-year [QALY]) and stage III ($46,860/QALY) patients, while cfEBV DNA-guided PET/CT was most cost-effective for stage IV patients ($62,269/QALY). However, routine follow-up was adequate for stage I patients due to their low recurrence risk. Conclusions The cfEBV DNA-guided imaging strategies are effective and cost-effective follow-up methods in NPC. These liquid biopsy-based strategies offer evidence-based, stage-specific surveillance modalities for clinicians and reduce disease burden for patients.
- Subjects :
- medicine.medical_specialty
Epstein-Barr Virus Infections
Herpesvirus 4, Human
Cost effectiveness
Posttreatment surveillance
Cost-Benefit Analysis
Positron Emission Tomography Computed Tomography
Surveillance imaging
medicine
Nasopharyngeal carcinoma
Humans
Circulating cell-free Epstein-Barr virus DNA
Stage (cooking)
Liquid biopsy
medicine.diagnostic_test
business.industry
Magnetic resonance imaging
Nasopharyngeal Neoplasms
General Medicine
DNA
medicine.disease
Bone scintigraphy
Positron emission tomography
Biomarker (medicine)
Medicine
Cost-effectiveness
Radiology
Neoplasm Recurrence, Local
business
Research Article
Subjects
Details
- Language :
- English
- ISSN :
- 17417015
- Volume :
- 19
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- BMC Medicine
- Accession number :
- edsair.doi.dedup.....4f3a823152f0404faaae85d07150e34d