【摘要】：目的:應(yīng)用Markov模型對(duì)假設(shè)40歲胃癌高危人群(10 000人)進(jìn)行不同胃鏡監(jiān)測(cè)隨訪策略間的成本效果分析,探索當(dāng)前經(jīng)濟(jì)水平下對(duì)胃癌高危人群進(jìn)行長(zhǎng)期胃鏡監(jiān)測(cè)隨訪的最優(yōu)策略。方法:考慮胃部不同疾病狀態(tài)進(jìn)展比例,模擬10 000例胃癌高�；颊�,評(píng)估2種隨訪策略:每年篩查一次的胃鏡監(jiān)測(cè)、每2 a篩查一次的胃鏡監(jiān)測(cè)。通過(guò)建立合適的Markov模型建立高危到胃癌發(fā)生的各種狀態(tài),以每1 a為周期計(jì)算出成本、效果,循環(huán)30 a后,計(jì)算出3種策略的增量成本效果比(ICER)進(jìn)行比較,并通過(guò)敏感性分析評(píng)價(jià)參數(shù)對(duì)模型穩(wěn)定性的影響。結(jié)果:每年篩查一次策略、每2 a篩查一次策略與不篩查策略相比分別減少了胃癌死亡人數(shù)381、193例。每年篩查一次策略與不篩查策略相比增加4 835.20個(gè)質(zhì)量調(diào)整壽命年(QALY),其ICER為22 758.41元/QALY。每2 a篩查一次策略與不篩查策略相比增加2 509.20個(gè)QALY,其ICER為21 974.07元/QALY。結(jié)論:在支付意愿為52 000元時(shí),對(duì)40歲人群進(jìn)行每年篩查一次或每2 a篩查一次監(jiān)測(cè)策略均為有成本效果,最優(yōu)策略為每年篩查一次。
[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.
【作者單位】： 徐州醫(yī)科大學(xué)公共衛(wèi)生學(xué)院流行病與衛(wèi)生統(tǒng)計(jì)學(xué)教研室;
【基金】：江蘇省科技廳社會(huì)發(fā)展項(xiàng)目BE2011647
【分類(lèi)號(hào)】：R735.2

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