This paper outlines a method for cost-utility analysis of liver screening for metastases in patients with posterior uveal melanoma (UM). A semiparametric model of the cumulative incidence of onset of liver metastases was fitted to a retrospective data set of 615 subjects with clinical follow-up with respect to liver surveillance imaging and outcome. The model was internally validated via bootstrap resampling in terms of its discrimination and calibration performance. Receiver operating characteristics (ROC) were derived at different time points. The discrimination performances are consistent across time. The area under the ROC curve at 5 years post treatment was 0.85 [95% CI: 0.81–0.88]. A goodness-of-fit test gives ${\chi }^2\left(10\right)=5.3,p=0.9$ demonstrating no evidence against the null hypothesis of zero difference between observed and expected onset of metastatic events. Results showed that at 80% sensitivity, 87% of UM patients will avoid unnecessary radiological scans. This provides potential cost savings of between £46,000 and £97,000 per year to the National Health Service assuming 600 new cases per year.

本文概述了一种用于葡萄膜后部黑色素瘤（UM）患者肝转移筛查的成本-效用分析方法。肝转移发作累积发生率的半参数模型适用于615名受试者的回顾性数据集，并就其肝监视影像和结果进行了临床随访。该模型在识别和校准性能方面通过自举重采样进行了内部验证。接收器工作特性（ROC）是在不同时间点得出的。歧视表现在时间上是一致的。治疗后5年的ROC曲线下面积为0.85 [95％CI：0.81-0.88]。拟合优度检验给出${\chi }^2（10）=5.3，p=0.9$没有证据表明观察到的转移性事件与预期的转移性事件之间零差异的零假设无效。结果表明，在80％的敏感性下，87％的UM患者将避免不必要的放射学扫描。假设每年有600例新病例，这将为国家卫生局每年节省46,000英镑至97,000英镑之间的潜在成本。