胃癌高危人群胃镜监测策略的卫生经济学评价

发布时间：2018-12-16 22:19

【摘要】：目的基于年龄和性别,评价胃癌高危人群胃镜监测的卫生经济学效果,确定目前经济水平下对胃癌高危人群进行长期胃镜监测的最优策略。方法构建基于胃癌自然史的Markov模型,模拟评估两种筛查方案:每年筛查一次和每两年筛查一次,并将没有胃镜筛查作为对照方案,计算质量调整寿命年、增量成本效果比等经济学指标。结果筛查起始年龄为40岁、45岁、50岁时,每年筛查一次的增量成本效果比(ICER)(元/QALYs)分别为23604.7、31287.4、44439.2,均小于支付意愿52000,且每年筛查一次的质量调整寿命年(QALYs)均大于每两年筛查一次和不筛查策略,故胃镜监测的最优策略为每年筛查一次。筛查年龄55岁时,每年筛查一次和每两年筛查一次的ICER(元/QALYs)分别为71382.3、60537.6,不具有成本效果,故55岁后筛查效果较差。不同性别分组不改变最优策略的选择。结论随着筛查年龄的不断增大,三种策略的成本和效果均不断降低,55岁前每年筛查一次为胃镜监测的最优策略。
[Abstract]:Objective to evaluate the effect of gastroscopy monitoring in high risk population of gastric cancer on the basis of age and sex, and to determine the optimal strategy of long-term gastroscopy monitoring for high risk population of gastric cancer at present economic level. Methods the Markov model based on the natural history of gastric cancer was constructed, and two screening schemes were simulated and evaluated: once a year and every two years, and no gastroscope screening was used as a control program to calculate the quality-adjusted life years (QLYs). Incremental cost effectiveness ratio and other economic indicators. Results at the age of 40, 45 and 50, the incremental cost effect of screening once a year was 23604.7 / QALYs (31287.4 / 444439.2), which was less than that of willingness to pay (52000). Moreover, the (QALYs) of quality adjusted life years is larger than that of every two years and no screening strategy, so the best strategy of gastroscopy is to screen once a year. At the age of 55, the ICER (yuan / QALYs) of every year and every two years was 71382.3 / QALYs, which was not cost effective, so the screening effect was poor after 55 years of age. Gender groups do not change the choice of optimal strategies. Conclusion with the increasing of screening age, the cost and effect of the three strategies are all decreasing. The best strategy for gastroscopy monitoring is to screen once a year before 55 years old.
【作者单位】：徐州医科大学公共卫生学院;
【基金】：江苏省科技厅社会发展项目(BE2011647)
【分类号】：R735.2

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