發(fā)布時(shí)間：2018-04-19 08:08

  本文選題：乳腺癌篩查 + 乳腺超聲�。� 參考：《中國衛(wèi)生政策研究》2017年04期

【摘要】：目的:評(píng)價(jià)中國女性使用乳腺超聲、鉬靶X線和不篩查三種乳腺癌篩查方式的成本效果和成本效用。方法:采用中國數(shù)據(jù),建立Markov決策模型,對(duì)每年進(jìn)行一次乳腺超聲篩查、每年進(jìn)行一次鉬靶X線篩查和不篩查的40歲以上女性進(jìn)行終生隊(duì)列模擬,以3%貼現(xiàn)率進(jìn)行貼現(xiàn)。以不篩查組的成本和效用作為基線得到增量成本效用比,并使用單因素敏感度分析和概率敏感度分析驗(yàn)證模型的穩(wěn)健性,同時(shí)對(duì)中東西部地區(qū)和不同類型城市進(jìn)行亞組分層分析。結(jié)果:與不篩查相比,乳腺超聲篩查和鉬靶X線篩查的增量成本效用比分別為102 653元/QALY和201 309元/QALY。概率敏感度分析結(jié)果顯示,乳腺超聲和鉬靶X線具有成本效用的概率分別為54.5%和26.2%。乳腺超聲篩查在不同地區(qū)和不同類型城市的亞組分析結(jié)果無差異,鉬靶X線篩查在東部地區(qū)的增量成本效用比與意愿支付閾值接近。結(jié)論:乳腺超聲篩查可考慮作為我國乳腺癌篩查項(xiàng)目的主要方法,但鉬靶X線篩查只適合在東部經(jīng)濟(jì)較發(fā)達(dá)地區(qū)使用。
[Abstract]:Objective: to evaluate the cost effectiveness and effectiveness of mammography, mammography and non-screening for breast cancer screening in Chinese women.Methods: using Chinese data, Markov decision-making model was established, mammography screening was performed once a year, mammography screening was performed once a year and lifetime cohort simulation was performed for women over 40 years of age who were not screened. The discount rate was 3%.The incremental cost-utility ratio was obtained by using the cost and utility of the non-screening group as a baseline, and the robustness of the model was verified by single-factor sensitivity analysis and probabilistic sensitivity analysis.At the same time, the subgroup stratification analysis was carried out in the central, eastern and western regions and different types of cities.Results: compared with non-screening, the incremental cost-effectiveness ratios of breast ultrasound screening and mammography screening were 102,653 yuan / QALY and 201,309 yuan / QALYY, respectively.The probabilistic sensitivity analysis showed that the probability of cost effectiveness of mammography and mammography was 54.5% and 26.2% respectively.There was no difference in the subgroup analysis results of mammography in different regions and different cities. The incremental cost-effectiveness ratio of mammography screening in the eastern region was close to the threshold of willingness to pay.Conclusion: breast ultrasound screening can be considered as the main method of breast cancer screening in China, but mammography screening is only suitable for the more developed areas in eastern China.
【作者單位】： 北京大學(xué)公共衛(wèi)生學(xué)院;倫敦衛(wèi)生與熱帶醫(yī)學(xué)院;
【基金】：國家自然科學(xué)基金面上項(xiàng)目(71273016,71673004)
【分類號(hào)】：R730.44;R737.9

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