幽门螺旋杆菌根除治疗预防胃癌的Markov模型及其卫生经济学分析
发布时间：2018-07-14 09:03
【摘要】：背景和目的:胃癌是人类疾病中唯一与细菌感染直接相关的肿瘤,幽门螺旋杆菌(Helicobacter pylori,Hp)作为致癌病原体在人群的流行率高达50%,但是Hp感染人群,尤其是无症状的感染群体,是否应行根除治疗仍存有争议。本研究从卫生经济学角度和人群水平出发,对比确诊Hp感染的患者群体是否行根除治疗所产生的效果和费用差异,为无症状感染人群的医疗服务提供新的决策思路。方法:用Markov队列模型分别估计根除组进行Hp根除治疗和对照组不进行根除治疗的长期效果和费用,模型所需参数来自于已发表的文献和权威网站。直接指标包括两组各状态分布及胃癌发病情况、平均生命年、平均质量调整生命年、平均总费用及平均胃癌治疗相关费用等;增量分析主要为每增加一个生命年所增加或减少的费用、每增加一个治疗调整生命年所增加或减少的费用。最后结合浙江省相关资料进行估算全省人群水平的获益。结果:在整个研究的过程中,根除组胃癌的发生例数始终少于对照组,且根除组累积死亡率(55.70%)低于对照组累积死亡率(65.29%)(P0.01)。根除组累积获得约28万个生命年,累积获得约26万个质量调整生命年,用于胃癌的直接总费用约为28577万元。对照组累积获得约26万个生命年,累积获得约21万个质量调整生命年,用于胃癌的直接总费用约为35853万元。增量分析发现每延长一个生命年的同时能节约3318.18元的相关医疗费用,每延长一个质量调整生命年的同时能减少1428.57元的相关医疗费用。实例分析对浙江省内Hp阳性的40岁人群行根除治疗不仅能够有效减少胃癌的发病人数,与不行根除治疗相比可累积多延长125.27万个生命年,291.29万个质量调整生命年,减少5.47万死亡人数,共计可以节约41.51亿元。结论:利用Markov模型模拟Hp感染到胃癌的自然病程,可以发现Hp根除治疗可以有效减少感染人群中胃癌的发病率,降低人群死亡率。卫生经济学方面,根除治疗后,Hp感染导致的胃癌直接相关的费用也相应地减少。因此,在Hp感染人群中,包括无症状的感染者中,推荐进行根除治疗。
[Abstract]:Background & objective: gastric cancer is the only tumor directly related to bacterial infection in human diseases. Helicobacter pylori (HP) is a carcinogenic pathogen with a prevalence rate of 50%. Whether eradication treatment should be carried out remains controversial. From the point of view of health economics and population level, this study compared the effect and cost difference of eradication therapy in patients with HP infection, and provided a new decision-making idea for the medical service of asymptomatic infection population. Methods: Markov cohort model was used to estimate the long-term effect and cost of HP eradication therapy in eradication group and non-eradication therapy in control group. The parameters of the model were obtained from published literature and authoritative websites. The direct indexes included the distribution of each state and the incidence of gastric cancer, the average life year, the average quality adjusted life year, the average total cost and the average cost of gastric cancer treatment. Incremental analysis mainly refers to the increased or decreased cost per additional life year and the increased or reduced cost per additional treatment adjusted life year. Finally, the benefit of population level in Zhejiang Province is estimated by combining relevant data of Zhejiang Province. Results: during the whole study, the incidence of gastric cancer in the eradication group was always less than that in the control group, and the cumulative mortality rate in the eradication group (55.70%) was lower than that in the control group (65.29%) (P0.01). In the eradication group, about 280000 life years and 260000 quality-adjusted life years were accumulated, and the total direct cost for gastric cancer was about 285.77 million yuan. In the control group, about 260000 life years and 210000 quality-adjusted life years were accumulated, and the total direct cost for gastric cancer was about 358.53 million yuan. Incremental analysis found that each extension of one life year at the same time can save 3318.18 yuan of related medical expenses, each extension of a quality adjustment life year at the same time can reduce 1428.57 yuan of related medical expenses. The case study shows that eradication therapy for 40 years old people with HP positive in Zhejiang province can not only effectively reduce the number of gastric cancer, but also prolong the cumulative life years of 125.27 million and 2.912 million quality-adjusted life years in comparison with the non-eradication treatment. By reducing the number of deaths by 54700, you can save a total of 4.151 billion yuan. Conclusion: using Markov model to simulate the natural course of HP infection into gastric cancer, it can be found that HP eradication therapy can effectively reduce the incidence of gastric cancer and reduce the mortality of the population. In terms of health economics, the cost of gastric cancer directly associated with HP infection after eradication has been reduced accordingly. Therefore, eradication therapy is recommended in people with HP infection, including asymptomatic infections.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2
，
本文编号：2121155
[Abstract]:Background & objective: gastric cancer is the only tumor directly related to bacterial infection in human diseases. Helicobacter pylori (HP) is a carcinogenic pathogen with a prevalence rate of 50%. Whether eradication treatment should be carried out remains controversial. From the point of view of health economics and population level, this study compared the effect and cost difference of eradication therapy in patients with HP infection, and provided a new decision-making idea for the medical service of asymptomatic infection population. Methods: Markov cohort model was used to estimate the long-term effect and cost of HP eradication therapy in eradication group and non-eradication therapy in control group. The parameters of the model were obtained from published literature and authoritative websites. The direct indexes included the distribution of each state and the incidence of gastric cancer, the average life year, the average quality adjusted life year, the average total cost and the average cost of gastric cancer treatment. Incremental analysis mainly refers to the increased or decreased cost per additional life year and the increased or reduced cost per additional treatment adjusted life year. Finally, the benefit of population level in Zhejiang Province is estimated by combining relevant data of Zhejiang Province. Results: during the whole study, the incidence of gastric cancer in the eradication group was always less than that in the control group, and the cumulative mortality rate in the eradication group (55.70%) was lower than that in the control group (65.29%) (P0.01). In the eradication group, about 280000 life years and 260000 quality-adjusted life years were accumulated, and the total direct cost for gastric cancer was about 285.77 million yuan. In the control group, about 260000 life years and 210000 quality-adjusted life years were accumulated, and the total direct cost for gastric cancer was about 358.53 million yuan. Incremental analysis found that each extension of one life year at the same time can save 3318.18 yuan of related medical expenses, each extension of a quality adjustment life year at the same time can reduce 1428.57 yuan of related medical expenses. The case study shows that eradication therapy for 40 years old people with HP positive in Zhejiang province can not only effectively reduce the number of gastric cancer, but also prolong the cumulative life years of 125.27 million and 2.912 million quality-adjusted life years in comparison with the non-eradication treatment. By reducing the number of deaths by 54700, you can save a total of 4.151 billion yuan. Conclusion: using Markov model to simulate the natural course of HP infection into gastric cancer, it can be found that HP eradication therapy can effectively reduce the incidence of gastric cancer and reduce the mortality of the population. In terms of health economics, the cost of gastric cancer directly associated with HP infection after eradication has been reduced accordingly. Therefore, eradication therapy is recommended in people with HP infection, including asymptomatic infections.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2
，
本文编号：2121155
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