本文關(guān)鍵詞： 肺結(jié)核 患者發(fā)現(xiàn) 決策樹 成本-效果分析　出處：《中國疾病預(yù)防控制中心》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的通過研究肺結(jié)核患者不同發(fā)現(xiàn)策略的成本效果,確定在肺結(jié)核可疑癥狀者和重點(diǎn)人群中開展肺結(jié)核患者發(fā)現(xiàn)的最優(yōu)策略,為衛(wèi)生決策者因地制宜制定肺結(jié)核患者發(fā)現(xiàn)策略提供科學(xué)依據(jù)。 方法 1.通過文獻(xiàn)研究確定針對活動(dòng)性肺結(jié)核患者的不同診斷技術(shù)組合； 2.通過文獻(xiàn)研究、人群歸因危險(xiǎn)分值排序和可行性考慮,確定適合在我國開展肺結(jié)核患者發(fā)現(xiàn)工作的重點(diǎn)人群； 3.建立決策樹模型,收集參數(shù)和參數(shù)敏感度分析范圍,進(jìn)行成本-效果分析確定每種人群的最優(yōu)策略,進(jìn)行敏感度分析檢驗(yàn)?zāi)Ｐ偷姆�(wěn)定性； 4.匯總不同人群的最優(yōu)策略的成本效果,考慮相互之間的交叉重復(fù),獲得最優(yōu)策略應(yīng)用于全人群的成本效果。 結(jié)果 1.確定了5種肺結(jié)核患者發(fā)現(xiàn)策略：策略1：對目標(biāo)人群先進(jìn)行胸部X線檢查和痰涂片鏡檢,對有臨床表現(xiàn)或X線檢查懷疑肺結(jié)核但涂片檢查陰性者進(jìn)行固體痰培養(yǎng)；策略2：對目標(biāo)人群先進(jìn)行線索調(diào)查,然后對線索調(diào)查獲得的可疑癥狀者和該目標(biāo)人群中主動(dòng)就診的可疑癥狀者進(jìn)行胸部X線檢查和痰涂片鏡檢,對有臨床表現(xiàn)或X線檢查懷疑肺結(jié)核但涂片檢查陰性者進(jìn)行固體痰培養(yǎng)；策略3：對目標(biāo)人群先進(jìn)行詢問癥狀和胸部X線檢查,任何一項(xiàng)有異常者進(jìn)行痰涂片檢查,對涂陰者做痰培養(yǎng)；策略4：對目標(biāo)人群先進(jìn)行詢問癥狀和胸部X線檢查,任何一項(xiàng)有異常者進(jìn)行痰涂片LED鏡檢,對涂陰者做痰培養(yǎng)；策略5：對目標(biāo)人群先進(jìn)行詢問癥狀和胸部X線檢查,任何一項(xiàng)有異常者進(jìn)行GeneXpert檢查。 2.確定的重點(diǎn)人群為老年人、糖尿病患者和涂陽肺結(jié)核患者密切接觸者。 3.對于可疑癥狀者,策略2是進(jìn)行患者發(fā)現(xiàn)的最大效果策略,策略4為最高效率策略；對于老年人群,策略3是進(jìn)行患者發(fā)現(xiàn)的最大效果策略,策略1為最高效率策略；對于糖尿病患者和涂陽密接者,策略4是進(jìn)行肺結(jié)核患者發(fā)現(xiàn)的最大效果策略,策略1為最高效率策略；敏感度分析顯示各參數(shù)在設(shè)定的范圍內(nèi)變化不影響模型分析的結(jié)果。 4.最大效果策略應(yīng)用于全人群花費(fèi)的成本為1720.5萬元,能夠發(fā)現(xiàn)2367例肺結(jié)核患者；最高效率策略應(yīng)用于全人群花費(fèi)的成本為279.8萬元,能夠發(fā)現(xiàn)1387例肺結(jié)核患者。 結(jié)論 1.使用痰涂片LED鏡檢替代痰涂片傳統(tǒng)鏡檢能夠獲得更高的收益； 2.為了發(fā)現(xiàn)更多的肺結(jié)核患者,可疑癥狀者應(yīng)采用策略2,老年人群應(yīng)采用策略3,糖尿病患者和涂陽密接者應(yīng)采用策略4； 3.為了實(shí)現(xiàn)最高效的肺結(jié)核患者發(fā)現(xiàn),可疑癥狀者應(yīng)采用策略4,老年人群、糖尿病患者和涂陽密接者應(yīng)采用策略2； 4.現(xiàn)階段,對所有的重點(diǎn)人群單獨(dú)開展肺結(jié)核患者發(fā)現(xiàn)不符合成本效益原則,未來可以考慮在具有多重危險(xiǎn)因素的人群中做進(jìn)一步的研究。
[Abstract]:Objective to study the cost effect of different detection strategies for pulmonary tuberculosis patients, and to determine the best strategy for the detection of pulmonary tuberculosis patients among suspected symptoms and key population. To provide scientific basis for health decision makers to formulate strategies for finding tuberculosis patients according to local conditions. Method 1. To determine the different diagnostic techniques for active pulmonary tuberculosis patients through literature research; 2.Through the literature research, the classification of population attribution risk and the feasibility consideration, the key population suitable for TB discovery in China was determined. 3. Establish the decision tree model, collect the parameters and their sensitivity analysis range, make cost-effect analysis to determine the optimal strategy for each population, and test the stability of the model by sensitivity analysis. 4. Sum up the cost effect of the optimal strategy of different population, consider the crossover between each other, and obtain the cost effect of the optimal strategy applied to the whole population. Results 1. Five strategies for finding pulmonary tuberculosis patients were determined. Strategy 1: chest X-ray examination and sputum smear examination were performed on the target population first. Solid sputum culture was performed on patients with clinical manifestations or suspected pulmonary tuberculosis but negative smear examination. Strategy 2: the target group was investigated with clues first, and then chest X-ray examination and sputum smear examination were carried out on the suspicious symptoms obtained by the clue investigation and the suspicious symptoms of the target group. Solid sputum culture was performed on patients with clinical manifestations or suspected pulmonary tuberculosis but negative smear examination. Strategy 3: the target population was examined for symptoms and chest X-ray, any abnormal sputum smear examination and sputum culture for negative smear; Strategy 4: ask for symptoms and chest X-ray examination of the target population first, any one of the abnormal sputum smear LED examination, the smear negative for sputum culture; Strategy 5: ask the target group for symptoms and chest X-ray examination, any abnormal for GeneXpert examination. 2. The key population was the elderly, diabetic patients and smear positive pulmonary tuberculosis patients in close contact. 3. For patients with suspicious symptoms, strategy 2 is the most effective strategy for patient detection, and strategy 4 is the highest efficiency strategy. For the elderly, strategy 3 was the most effective strategy for patient discovery, and strategy 1 was the highest efficiency strategy. For diabetic patients and smear positive patients, strategy 4 was the most effective strategy for finding pulmonary tuberculosis, and strategy 1 was the highest efficiency strategy. Sensitivity analysis shows that the variation of the parameters within a given range does not affect the results of the model analysis. 4. The cost of applying the maximum effect strategy to the whole population is seventeen million two hundred and five thousand yuan, which can detect 2 367 cases of pulmonary tuberculosis. The maximum efficiency strategy cost two million seven hundred and ninety-eight thousand yuan to apply to the whole population, and can detect 1, 387 cases of pulmonary tuberculosis. Conclusion 1. The use of sputum smear LED to replace the traditional sputum smear examination can obtain higher income. 2. In order to find more patients with pulmonary tuberculosis, strategy 2 should be used for suspicious symptoms, strategy 3 should be adopted for the elderly, and strategy 4 should be used for diabetics and smear positive persons. 3. In order to find the most effective pulmonary tuberculosis patients, strategy 4 should be adopted for suspicious symptoms, and strategy 2 should be adopted for the elderly, diabetes patients and smear positive persons. 4. At this stage, it is not cost-effective to identify tuberculosis patients in all key populations alone, and further research in populations with multiple risk factors could be considered in the future.
【學(xué)位授予單位】：中國疾病預(yù)防控制中心
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R521

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