摘要
背景:基于国内现实情况,伺机性筛查(OS)被推荐用于结直肠癌(CRC)的筛查和早期诊断,但国内尚缺乏比较OS和人群筛查(MS)的卫生经济学评估研究。目的:通过建立状态转移Markov模型以评估OS和MS两种模式的成本效果。方法:Markov模型设定每个模式各100 000例人进入筛查,以10年为一观察周期。筛查相关的直接费用、CRC分期相关评估费用、住院费用和相关并发症费用被包括在Markov模型中,但不包括间接费用。结直肠肿瘤筛查和管理产生的效果以增加生命年表示,成本效果分析以增量成本效果比(ICER)来评估。同时行敏感性分析。结果:OS和MS分别可预防56.79%和74.85%的CRC发生,分别增加167 185和135 254生命年。与无筛查模式相比,OS模式和MS模式增量成本分别为-1.22亿元和-0.8亿元;ICER分别为-730元和-594元。OS模式对结肠镜、粪便隐血试验、腺瘤摘除术和进展期结直肠癌的费用不敏感。结论:OS模式在结直肠肿瘤筛查和处理中更具有成本效果,应在国内临床实践中推广应用。
Based on the real domestic situation, opportunistic screening （OS） is generally recommended for early screening and early detection of colorectal cancer （CRC）. However, economic analysis of 0S and mass screening （MS） has not seen reported in China. Aims ： To compare the cost-effectiveness of OS and MS by state-transition Markov model. Methods： Markov model was the simulated 100 000 individuals accepting OS or MS based on 10 years as an observation cycle. Direct costs such as screening-related direct cost, CRC staging-related cost, hospitalization cost and complication- related cost were included, and indirect costs were excluded from the model. The effectiveness of colorectal neoplasm screening and management was expressed by incremental life years. Incremental cost-effectiveness ratio （ICER） was used to evaluate cost-effectiveness of the different screening strategies. Sensitivity analysis was performed. Results ： OS and MS could reduce the incidence of CRC by 56.79% and 74.85% , respectively, and increase 167 185 and 135 254 life years, respectively. Compared with mode without screening, incremental cost of OS and MS were - 122 million RMB and -80 million RMB, ICER were - 730 RMB and - 594 RMB, respectively. OS was not sensitive to the cost of colonoscopy examination, fecal occult blood test, adenoma resection, and advanced colorectal cancer. Conclusions： OS is suggested to be the more cost-effective strategy for screening and management of colorectal neoplasm and may be recommended in China.
作者
李小刚
王建丰
陈莉
项伟艳
王登杰
王震华
吴云霞
王潍
LI Xiaogang WANG Jianfeng CHEN Li XIANG Weiyan WANG Dengjie WANG Zhenhua WU Yunxia WANG Wei(Department of Gastroenterology, Dachang Hospital of Baoshan District, Shanghai （200444 Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai)
出处
《胃肠病学》
2016年第9期528-533,共6页
Chinese Journal of Gastroenterology
基金
宝山区科技发展资金项目(13-E-40)资助
关键词
结直肠肿瘤
伺机性筛查
普查
成本效果分析
MARKOV模型
Colorectal Neoplasms
Opportunistic Screening
Mass Screening
Cost-Effectiveness Analysis
Markov Model
