摘要
目的：应用成本效果分析评价筛查对有关肝癌医疗成本的影响；方法：自1993年1月起，将18816名肝癌高危对象随机分为筛查组9373人，对照组9443人。筛查组每半年作一次AFP和超声检查，对照组不作主动检查。两组肝癌患者均予合理的治疗并随访。成本只计算直接医疗成本，效果为延长的生命年，进行成本效果分析和灵敏度分析；结果：随访至1997年12月，筛查组共发现肝癌患者86例，对照组51例。在58.2％的依从性下，筛查组平均每人用于肝癌防治的成本为126元，而对照组为117元。筛查组患者的病期相对较早；通过筛查降低了28％的肝癌死亡率；对每100000对象经过1年的筛查可以获得508.4个延长的生命年。每获得一个延长的生命年的成本为1775元。肝癌发病率越高，成本越低，效果越好；筛查试验的灵敏度、特异性越高，效果越好，成本效果比越小。依从性越好，效果越好，但成本效果比基本不变；结论：尽管筛查并不降低肝癌防治的成本，却可获得较好的效果。选取发病率高的人群是保证筛查效果的重点之一，提高依从性可明显地增加筛查的效果。
objective: to assess the impact of screening program on medical expenditures for primary liver cancer (PLC) in China Methch: 18816 high - risk subjects of PLC were randomized allocated into screening (9373) or control (9443). AFP comined with ultrasond was offered to participants in the screening group evny 6 months, controls were not told about the study and received no test. PLC patients in two groups were treated appropriately and followed up. Only direct medical asts were determined in the study,the effectiveness was year of life saved. Cost - effectivenase analyses and sensitivity analyas were conducted. Results: up to Dec.1997, there were 86 PLC patients in the screening grop and 51 in the control group. Under the assumption of compliance of 58. 2 %,Total cost per person screened was 126 RMB, compared with the cost per person in contnd group of 117 RMB. The PLC patients in scredng group were in relative earlier stages; Screening for decreased 28 percent of mortality from PLC. Screening would save 508. 3 years of life per 100,000 persons screened for one year, thus offering a cost - effectiveness ratio of 1775 RMB per year of life saved.The incidence of PLC, sensitivity and speificity of screening test, and compliance rate would impact the cost - effectiveness of the program. Conclusions: Though it is no likely to reduce medital expenditures for PLC, Screening can reduce the mortality rate from PLC. Screening program would be more cost - effective in higher PLC incidence; increase of compliance of screening would greatly improve the effectiveness of sereening.
出处
《中国临床医学》
1999年第2期106-108,共3页
Chinese Journal of Clinical Medicine
关键词
肝癌
筛查
成本效果分析
灵敏度
Primary hepatic cancer Screening Cost - effectiveness analysis Sensitivity analysis
