摘要
目的 对12种由乳腺临床检查（CBE）、乳腺超声检查（US）和乳腺钼靶X线检查（MAM）单独和联合使用组成的乳腺癌筛查模式进行成本效果分析，以期为上海市女性乳腺癌筛查最优方案的制定提供参考和借鉴。方法 利用2008-2012年上海市闵行区同期开展的乳腺癌高危人群筛查项目和乳腺癌有组织筛查项目所获得的信息和成本数据，结合文献相关参数，建立Markov决策树模型。采用队列分析法，以1年为循环周期，共循环40年，模拟10万名45岁女性人群中各种筛查策略下的成本效果。增量成本效果比作为筛选优势策略的指标。通过敏感性分析，评估不同因素对结果的影响大小。结果 在10万名45岁女性中采用不同的筛查策略，进行成本效果分析，结果显示，两年1次CBE结合对阳性者进行US和MAM并联筛查的模式最具成本效果，每挽救1个生命年的成本为182 526元，每增加1个质量调整生命年的成本为144 386元，在可接受的阈值内。敏感性分析结果显示，在最优模式下，上海地区因乳腺癌发病率远超全国平均水平，每增加1个质量调整生命年的成本比全国平均水平低64 836元。结论 上海市女性两年1次CBE结合对阳性者进行US和MAM并联筛查最具成本效果。从社会角度，该筛查模式可以在上海地区推广。
Objective To determine the most cost-effective modality for breast cancer screening in women living in Shanghai.Methods A Markov model for breast cancer was redeveloped based on true effect which was derived from a project for detection of women at high risk of breast cancer and an organized breast cancer screening program conducted simultaneously in Minhang district, Shanghai, during 2008 to 2012. Parameters of the model were derived from literatures. General principles related to cost-effectiveness analysis were used to compare the costs and effects of 12 different screening modalities in a simulated cohort involving 100 000 women aged 45 years. Incremental cost-effectiveness ratio （ICER） was used to determine the most cost-effective modality. Sensitivity analysis was conducted to evaluate how these factors affected the estimated cost-effectiveness.Results The modality of biennial CBE followed by ultrasonic and mammography among those with positive CBE was observed as the most cost-effective one. The costs appeared as 182 526 Yuan RMB per life year gained and 144 386 Yuan RMB per quality adjusted life-year （QALY） saved, which were within the threshold of 2-3 times of local per capita Gross Domestic Product.Results from sensitivity analysis showed that, due to higher incidence rate of breast cancer in Shanghai, the cost per QALY would be 64 836 Yuan RMB lower in Shanghai than the average level in China.Conclusion Our research findings showed that the biennial CBE program followed by ultrasonic and mammography for those with positive CBE results might serve as the optimal breast cancer screening modality for Chinese women living in Shanghai, and thus be widely promoted in this population elsewhere.
出处
《中华流行病学杂志》
CAS
CSCD
北大核心
2017年第12期1665-1671,共7页
Chinese Journal of Epidemiology
基金
美国中华医学基金会（HPSS09-991）
上海市第四轮公共卫生计划重点学科建设课题（15GWZK0801）
