利用Markov模型进行胃癌高危人群胃镜监测的成本效果评价
发布时间：2019-01-15 23:40
【摘要】：目的:应用Markov模型对假设40岁胃癌高危人群(10 000人)进行不同胃镜监测随访策略间的成本效果分析,探索当前经济水平下对胃癌高危人群进行长期胃镜监测随访的最优策略。方法:考虑胃部不同疾病状态进展比例,模拟10 000例胃癌高危患者,评估2种随访策略:每年筛查一次的胃镜监测、每2 a筛查一次的胃镜监测。通过建立合适的Markov模型建立高危到胃癌发生的各种状态,以每1 a为周期计算出成本、效果,循环30 a后,计算出3种策略的增量成本效果比(ICER)进行比较,并通过敏感性分析评价参数对模型稳定性的影响。结果:每年筛查一次策略、每2 a筛查一次策略与不筛查策略相比分别减少了胃癌死亡人数381、193例。每年筛查一次策略与不筛查策略相比增加4 835.20个质量调整寿命年(QALY),其ICER为22 758.41元/QALY。每2 a筛查一次策略与不筛查策略相比增加2 509.20个QALY,其ICER为21 974.07元/QALY。结论:在支付意愿为52 000元时,对40岁人群进行每年筛查一次或每2 a筛查一次监测策略均为有成本效果,最优策略为每年筛查一次。
[Abstract]:Objective: to analyze the cost effect of different gastroscopic monitoring strategies in 10 000 people (10 000 people) assuming 40 years old gastric cancer by using Markov model, and to explore the optimal strategy of long-term gastroscopic follow-up for high risk population of gastric cancer at present economic level. Methods: ten thousand patients with high risk of gastric cancer were simulated by considering the proportion of different gastric diseases, and two follow-up strategies were evaluated: one every year for gastroscopy and one every two years for gastroscopy. By establishing a suitable Markov model to establish various states of high risk to gastric carcinogenesis, the cost and effect were calculated every 1 year cycle. After 30 years of cycle, the incremental cost effect of the three strategies was compared with that of (ICER). The influence of the parameters on the stability of the model was evaluated by sensitivity analysis. Results: the strategy of screening every two years reduced the death rate of gastric cancer by 381193 cases respectively. The annual screening strategy has an increase of 4 835.20 quality-adjusted life years (QALY),) compared with the non-screening strategy, and its ICER is 22 758.41 yuan / QALY.. Every 2a, the screening strategy increases by 2 509.20 QALY, compared with the non-screening strategy, and the ICER is 21 974.07 yuan / QALY.. Conclusion: when the willingness to pay is 52,000 yuan, it is cost effective to screen the 40-year-old population once a year or every 2 years, and the best strategy is once a year.
【作者单位】： 徐州医科大学公共卫生学院流行病与卫生统计学教研室;
【基金】：江苏省科技厅社会发展项目BE2011647
【分类号】：R735.2
本文编号：2409231
[Abstract]:Objective: to analyze the cost effect of different gastroscopic monitoring strategies in 10 000 people (10 000 people) assuming 40 years old gastric cancer by using Markov model, and to explore the optimal strategy of long-term gastroscopic follow-up for high risk population of gastric cancer at present economic level. Methods: ten thousand patients with high risk of gastric cancer were simulated by considering the proportion of different gastric diseases, and two follow-up strategies were evaluated: one every year for gastroscopy and one every two years for gastroscopy. By establishing a suitable Markov model to establish various states of high risk to gastric carcinogenesis, the cost and effect were calculated every 1 year cycle. After 30 years of cycle, the incremental cost effect of the three strategies was compared with that of (ICER). The influence of the parameters on the stability of the model was evaluated by sensitivity analysis. Results: the strategy of screening every two years reduced the death rate of gastric cancer by 381193 cases respectively. The annual screening strategy has an increase of 4 835.20 quality-adjusted life years (QALY),) compared with the non-screening strategy, and its ICER is 22 758.41 yuan / QALY.. Every 2a, the screening strategy increases by 2 509.20 QALY, compared with the non-screening strategy, and the ICER is 21 974.07 yuan / QALY.. Conclusion: when the willingness to pay is 52,000 yuan, it is cost effective to screen the 40-year-old population once a year or every 2 years, and the best strategy is once a year.
【作者单位】： 徐州医科大学公共卫生学院流行病与卫生统计学教研室;
【基金】：江苏省科技厅社会发展项目BE2011647
【分类号】：R735.2
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1 王倩 ,林果为 ,金丕焕 ,陈洁 ,徐三荣;筛查幽门螺杆菌预防胃癌的Markov模型卫生经济学评价[J];中华流行病学杂志;2003年02期
，本文编号：2409231
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