УЗЛЫ ШИТОВИДНОЙ ЖЕЛЕЗЫ: ГЛОБАЛЬНОЕ, ЭКОНОМИЧЕСКОЕ И ЛИЧНОЕ БРЕМЯ
Ключевые слова:
щитовидная железа, узлы, заболеваемость, анализАннотация
Узлы щитовидной железы привлекли внимание из-за изменений в системах наблюдения за населением и растущей обеспокоенности по поводу связанного с этим финансового бремени для систем здравоохранения, плательщиков и пациентов. В этом обзоре мы обнаружили, что показатели распространенности широко варьируются в зависимости от метода обнаружения и могут быть особенно выражены у бессимптомных пациентов, проходящих рутинный скрининг. Показатели заболеваемости могут особенно расти в странах с низким и средним уровнем дохода и могут снижаться в странах с более высоким уровнем дохода. За последние несколько десятилетий обследование и лечение узлов щитовидной железы стало более сложным с появлением тонкоигольной аспирационной биопсии, специализированных биомаркеров и молекулярного тестирования. Однако в стратификации риска остаются пробелы, которые могут привести к значительным затратам на лечение. Некоторые молекулярные тесты, такие как классификатор секвенирования генов Afirma, могут привести к тому, что затраты на диагностику составят 17 873 долларов США, при этом достигается лишь незначительное снижение количества диагностических лобэктомий у пациентов (с 11,6% до 9,7% в одном исследовании). Наличные расходы, связанные с лечением узлов щитовидной железы, продолжают приводить к значительной финансовой токсичности для пациентов, особенно для людей с раком щитовидной железы. Для улучшения существующих систем лечения узлов щитовидной железы необходим дополнительный анализ экономической эффективности, а также необходимы новые клинические инструменты, чтобы избежать ненужного обследования и лечения.
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