發(fā)布時(shí)間：2018-03-23 12:59

  本文選題：成本-效用　切入點(diǎn)：肺癌治療功能評(píng)價(jià)量表　出處：《北京中醫(yī)藥大學(xué)》2015年碩士論文

【摘要】：研究目的：以肺癌治療功能評(píng)價(jià)量表FACT-L為例,對(duì)映射法在效用值測(cè)量中的應(yīng)用進(jìn)行初探,構(gòu)建基于我國(guó)人群偏好的FACT-L到EQ-5D效用值的映射模型,將非偏好的生命質(zhì)量信息轉(zhuǎn)換為健康效用值從而應(yīng)用于肺癌治療領(lǐng)域的成本-效用評(píng)價(jià)之中。探索不同計(jì)量經(jīng)濟(jì)學(xué)方法、模型類型以及效用積分體系版本的選擇對(duì)映射結(jié)果的影響,并對(duì)最佳選擇給出建議意見,以期為我國(guó)今后開展的映射研究提供經(jīng)驗(yàn)借鑒。研究方法：本研究資料來自于“肺癌藥物經(jīng)濟(jì)學(xué)評(píng)價(jià)研究”課題中的歷史數(shù)據(jù)。根據(jù)納排標(biāo)準(zhǔn)選擇研究對(duì)象共676例,并收集其基本信息、FACT-L中文版(V4.0)以及中文版EQ-5D數(shù)據(jù),分別采用中、日、英三版效用值積分體系進(jìn)行效用值換算。將總體研究對(duì)象隨機(jī)區(qū)組分為構(gòu)建集(n=451)和驗(yàn)證集(n=225),并保證兩者之間基本人口學(xué)指標(biāo)的均衡性。運(yùn)用統(tǒng)計(jì)軟件,在構(gòu)建集基礎(chǔ)上,以普通最小二乘法、廣義線性模型、Tobit模型、截?cái)嘧钚〗^對(duì)離差以及分位數(shù)回歸五種計(jì)量經(jīng)濟(jì)學(xué)方法結(jié)合四種模型類型建立FACT-L到EQ-5D的備選模型,并以驗(yàn)證集對(duì)其進(jìn)行內(nèi)部驗(yàn)證。比較后選擇最佳方法和模型類型對(duì)總樣本進(jìn)行估計(jì),獲得最終的映射模型。模型效力主要從差異性檢驗(yàn)以及預(yù)測(cè)精度指標(biāo)如平均絕對(duì)誤差、均方根誤差等方面進(jìn)行評(píng)價(jià)。研究?jī)?nèi)容：首先,構(gòu)建基于我國(guó)人群偏好的FACT-L效用值映射模型；其次,探討映射法中不同計(jì)量經(jīng)濟(jì)學(xué)方法、模型類型以及效用積分體系的選擇應(yīng)用特點(diǎn)。研究結(jié)果：1.基于我國(guó)人群偏好的FACT-L到EQ-5D的映射中,包含有FACT-L維度得分及其兩兩交叉項(xiàng)和人口學(xué)、健康狀態(tài)變量的模型表現(xiàn)出最佳的預(yù)測(cè)能力。在最終映射模型中,主效應(yīng)生理狀況PWB、情感狀況EWB和癌癥子模塊LCS維度得分的回歸系數(shù)具有統(tǒng)計(jì)學(xué)意義。該模型的預(yù)測(cè)值與實(shí)際值相關(guān)系數(shù)rs=0.7187,為中偏高度相關(guān)；二者的總體分布及個(gè)體配對(duì)比較均無統(tǒng)計(jì)學(xué)差異；預(yù)測(cè)精度指標(biāo)MAE=0.0886,RMSE=0.1175,與國(guó)外映射研究結(jié)果相比,處于較優(yōu)水平。綜合來看,可認(rèn)為該映射模型預(yù)測(cè)能力良好。2.對(duì)于以EQ-5D作為目標(biāo)量表的映射研究,分位數(shù)回歸和截?cái)嘧钚〗^對(duì)離差較為適用,當(dāng)基于我國(guó)人群偏好時(shí),推薦將分位數(shù)回歸作為首選的計(jì)量經(jīng)濟(jì)學(xué)方法。當(dāng)起始量表為多維量表時(shí),推薦將以各維度得分作為自變量、以人口學(xué)指標(biāo)等作為協(xié)變量的模型類型。中、日、英三版EQ-5D效用積分體系結(jié)果的映射相比較,中版最優(yōu),其次為日版。因此,在映射中建議使用效用積分體系的本國(guó)版本或與本國(guó)人群最為貼近的他國(guó)版本。研究結(jié)論：運(yùn)用映射法基于我國(guó)人群偏好構(gòu)建的FACT-L到EQ-5D效用值的轉(zhuǎn)換模型,其預(yù)測(cè)能力良好,具有較高的模型效力,能夠較為精確地將我國(guó)肺癌患者的非偏好生命質(zhì)量信息轉(zhuǎn)換為健康效用值。當(dāng)研究中缺少效用值數(shù)據(jù)時(shí),可對(duì)健康相關(guān)生命質(zhì)量量表進(jìn)行映射,以此獲得的成本-效用分析結(jié)果能夠?yàn)榧膊≈委煷胧┑慕?jīng)濟(jì)性選擇提供依據(jù),為政府的衛(wèi)生資源配置和政策制定提供參考。映射法應(yīng)用時(shí),應(yīng)根據(jù)研究目的和目標(biāo)人群選擇適合的效用值積分體系版本,建議選擇研究對(duì)象的國(guó)家版本或與其最為貼近的他國(guó)版本；對(duì)于多維量表的映射,建議以維度得分作為自變量主效應(yīng),并加入其二階變量和人口學(xué)指標(biāo)協(xié)變量進(jìn)行調(diào)整與校正；此外還應(yīng)根據(jù)資料數(shù)據(jù)的類型特征靈活選擇計(jì)量經(jīng)濟(jì)學(xué)方法。
[Abstract]:Objective: To study the functional assessment of cancer FACT-L as an example, to make a preliminary study on the application of measurement in utility value in mapping method, construct the mapping model preference of Chinese population FACT-L to EQ-5D based on utility value, the quality of life for the non preference information into the health utility value evaluation from the utility and application in the field of lung cancer cost. To explore different econometric methods, effect and utility model type integral system version selection results of mapping, and to give advice on the best choice, in order to provide good experience for our future work on mapping. Research methods: the research data of historical data from "research" evaluation of lung cancer drug economics. According to the inclusive criteria for the selection of row in 676 subjects, and to collect the basic information, FACT-L Chinese Version (V4.0) and Chinese version of EQ-5D data, divided by In Japan, the British version three utility value integral system utility value conversion. Total subjects were randomly divided into set (n=451) and validation set (n=225), and to ensure the balance between the two basic demographic indicators. Using statistical software, set up in the basis, to the general least square method. The generalized linear model, Tobit model, truncated least absolute deviation and quantile regression five econometric method with alternative models of four kinds of model type FACT-L to EQ-5D, and the validation set to validate the internal comparison. Choose the best method and model types of total samples to obtain final estimation, mapping model the main difference from the model. The effectiveness of inspection and prediction accuracy indicators such as mean absolute error, root mean square error evaluation and so on. Research contents: first, construct the value preference of Chinese population FACT-L mapping based on Utility Model; secondly, explore the different econometric methods in the selection and application of feature mapping method, and the utility model type integral system. The research results: 1. based on the preference mapping population of our country's FACT-L to EQ-5D, including FACT-L score and 22 cross terms and demographic and health status variables model showed the best predictive ability in the final mapping model, the main effect of physiological condition PWB, statistically significant regression coefficients of emotional status EWB and cancer sub module LCS scores. The prediction value and the actual value of the correlation coefficient rs= 0.7187, is highly related to the overall distribution and partial; individual paired comparison of the two were not statistically significant; the prediction accuracy of MAE=0.0886 index, RMSE=0.1175, compared with foreign research results in a mapping, excellent level. In general, we can consider the mapping model good prediction ability for.2. With EQ-5D as the research target mapping scale, quantile regression and truncated least absolute deviation is appropriate when the preference of Chinese population based on quantile regression, is recommended as the preferred method of econometrics. When the initial scale for the multidimensional scale, each dimension score will be recommended as independent variables to demography model type indicators as covariates. In Japan, the British mapping three edition EQ-5D utility compared to the integral system results in the second edition, the best for the Japanese version. Therefore, the Chinese version is close to he in the map suggests the use of utility system and its integral version or its research conclusion: the use of population. China's population preference mapping method conversion to construct FACT-L to EQ-5D utility model based on the prediction ability of good effect, high model can accurately be non preference life quality of patients with lung cancer transfer information in China For the health utility value. When the utility value of lack of data in the research, the health related quality of life scale mapping, in order to obtain the cost utility analysis results can provide the basis for the selection of economic disease treatment measures, provide a reference for the allocation of health resources and policies for the government. The application of mapping method. Should choose according to the research purpose and target population of the utility value of integral system version, recommendations for the selection of research object and the national version or the Chinese version of his close; mapping on a multidimensional scale, to score as independent main effect, and adding second order variables and demographic indicators adjusted for covariates and correction; it should also be the econometrics method flexibly according to types of data.

【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 付希婧;梁敏洪;孫茂;高鵬;孔彩;朱文濤;;映射法在健康效用值測(cè)量中的應(yīng)用研究[J];中國(guó)衛(wèi)生經(jīng)濟(jì);2014年10期

2 張瀟;趙慶春;;兩種化療方案治療晚期非小細(xì)胞肺癌臨床評(píng)價(jià)及藥物經(jīng)濟(jì)學(xué)分析[J];實(shí)用藥物與臨床;2013年12期

3 何志高;嚴(yán)俊;陳國(guó)涵;鮑思蔚;翟曉波;金麗;施燕;;長(zhǎng)春瑞濱(NP)或吉西他濱(GP)聯(lián)合順鉑治療晚期非小細(xì)胞肺癌的成本效用研究[J];藥學(xué)實(shí)踐雜志;2012年06期

4 李洪超;范長(zhǎng)生;黃旭明;;吉非替尼治療晚期非小細(xì)胞肺癌的藥物經(jīng)濟(jì)學(xué)評(píng)價(jià)[J];中國(guó)新藥雜志;2012年17期

5 伍紅艷;孫利華;;兩種常用EQ-5D量表效用值積分體系的比較及其對(duì)成本效用分析結(jié)果的影響探討[J];中國(guó)衛(wèi)生經(jīng)濟(jì);2012年07期

6 劉勤;;衛(wèi)生經(jīng)濟(jì)學(xué)常用評(píng)價(jià)方法淺析[J];中國(guó)現(xiàn)代醫(yī)學(xué)雜志;2009年12期

7 李明暉;羅南;;歐洲五維健康量表(EQ-5D)中文版應(yīng)用介紹[J];中國(guó)藥物經(jīng)濟(jì)學(xué);2009年01期

8 李明暉;李洪超;馬愛霞;;近期國(guó)內(nèi)外藥物經(jīng)濟(jì)學(xué)評(píng)價(jià)研究文獻(xiàn)分析[J];中國(guó)藥物經(jīng)濟(jì)學(xué);2008年01期

9 薛小平;史東平;王彤;;受限因變量模型及其半?yún)?shù)估計(jì)[J];中國(guó)衛(wèi)生統(tǒng)計(jì);2007年02期

10 馮飛靈;韓天權(quán);雷若慶;張圣道;;重癥急性胰腺炎治療的生命價(jià)值研究(成本效用分析和生存質(zhì)量評(píng)估)[J];中華肝膽外科雜志;2006年11期

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