乳腺超声和钼靶X线对中国女性乳腺癌筛查的卫生经济学评价

发布时间：2018-04-19 08:08

本文选题：乳腺癌筛查 + 乳腺超声　；参考：《中国卫生政策研究》2017年04期

【摘要】：目的:评价中国女性使用乳腺超声、钼靶X线和不筛查三种乳腺癌筛查方式的成本效果和成本效用。方法:采用中国数据,建立Markov决策模型,对每年进行一次乳腺超声筛查、每年进行一次钼靶X线筛查和不筛查的40岁以上女性进行终生队列模拟,以3%贴现率进行贴现。以不筛查组的成本和效用作为基线得到增量成本效用比,并使用单因素敏感度分析和概率敏感度分析验证模型的稳健性,同时对中东西部地区和不同类型城市进行亚组分层分析。结果:与不筛查相比,乳腺超声筛查和钼靶X线筛查的增量成本效用比分别为102 653元/QALY和201 309元/QALY。概率敏感度分析结果显示,乳腺超声和钼靶X线具有成本效用的概率分别为54.5%和26.2%。乳腺超声筛查在不同地区和不同类型城市的亚组分析结果无差异,钼靶X线筛查在东部地区的增量成本效用比与意愿支付阈值接近。结论:乳腺超声筛查可考虑作为我国乳腺癌筛查项目的主要方法,但钼靶X线筛查只适合在东部经济较发达地区使用。
[Abstract]:Objective: to evaluate the cost effectiveness and effectiveness of mammography, mammography and non-screening for breast cancer screening in Chinese women.Methods: using Chinese data, Markov decision-making model was established, mammography screening was performed once a year, mammography screening was performed once a year and lifetime cohort simulation was performed for women over 40 years of age who were not screened. The discount rate was 3%.The incremental cost-utility ratio was obtained by using the cost and utility of the non-screening group as a baseline, and the robustness of the model was verified by single-factor sensitivity analysis and probabilistic sensitivity analysis.At the same time, the subgroup stratification analysis was carried out in the central, eastern and western regions and different types of cities.Results: compared with non-screening, the incremental cost-effectiveness ratios of breast ultrasound screening and mammography screening were 102,653 yuan / QALY and 201,309 yuan / QALYY, respectively.The probabilistic sensitivity analysis showed that the probability of cost effectiveness of mammography and mammography was 54.5% and 26.2% respectively.There was no difference in the subgroup analysis results of mammography in different regions and different cities. The incremental cost-effectiveness ratio of mammography screening in the eastern region was close to the threshold of willingness to pay.Conclusion: breast ultrasound screening can be considered as the main method of breast cancer screening in China, but mammography screening is only suitable for the more developed areas in eastern China.
【作者单位】：北京大学公共卫生学院;伦敦卫生与热带医学院;
【基金】：国家自然科学基金面上项目(71273016,71673004)
【分类号】：R730.44;R737.9

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