【摘要】：背景和目的:胃癌是人類疾病中唯一與細(xì)菌感染直接相關(guān)的腫瘤,幽門螺旋桿菌(Helicobacter pylori,Hp)作為致癌病原體在人群的流行率高達(dá)50%,但是Hp感染人群,尤其是無癥狀的感染群體,是否應(yīng)行根除治療仍存有爭(zhēng)議。本研究從衛(wèi)生經(jīng)濟(jì)學(xué)角度和人群水平出發(fā),對(duì)比確診Hp感染的患者群體是否行根除治療所產(chǎn)生的效果和費(fèi)用差異,為無癥狀感染人群的醫(yī)療服務(wù)提供新的決策思路。方法:用Markov隊(duì)列模型分別估計(jì)根除組進(jìn)行Hp根除治療和對(duì)照組不進(jìn)行根除治療的長(zhǎng)期效果和費(fèi)用,模型所需參數(shù)來自于已發(fā)表的文獻(xiàn)和權(quán)威網(wǎng)站。直接指標(biāo)包括兩組各狀態(tài)分布及胃癌發(fā)病情況、平均生命年、平均質(zhì)量調(diào)整生命年、平均總費(fèi)用及平均胃癌治療相關(guān)費(fèi)用等;增量分析主要為每增加一個(gè)生命年所增加或減少的費(fèi)用、每增加一個(gè)治療調(diào)整生命年所增加或減少的費(fèi)用。最后結(jié)合浙江省相關(guān)資料進(jìn)行估算全省人群水平的獲益。結(jié)果:在整個(gè)研究的過程中,根除組胃癌的發(fā)生例數(shù)始終少于對(duì)照組,且根除組累積死亡率(55.70%)低于對(duì)照組累積死亡率(65.29%)(P0.01)。根除組累積獲得約28萬個(gè)生命年,累積獲得約26萬個(gè)質(zhì)量調(diào)整生命年,用于胃癌的直接總費(fèi)用約為28577萬元。對(duì)照組累積獲得約26萬個(gè)生命年,累積獲得約21萬個(gè)質(zhì)量調(diào)整生命年,用于胃癌的直接總費(fèi)用約為35853萬元。增量分析發(fā)現(xiàn)每延長(zhǎng)一個(gè)生命年的同時(shí)能節(jié)約3318.18元的相關(guān)醫(yī)療費(fèi)用,每延長(zhǎng)一個(gè)質(zhì)量調(diào)整生命年的同時(shí)能減少1428.57元的相關(guān)醫(yī)療費(fèi)用。實(shí)例分析對(duì)浙江省內(nèi)Hp陽(yáng)性的40歲人群行根除治療不僅能夠有效減少胃癌的發(fā)病人數(shù),與不行根除治療相比可累積多延長(zhǎng)125.27萬個(gè)生命年,291.29萬個(gè)質(zhì)量調(diào)整生命年,減少5.47萬死亡人數(shù),共計(jì)可以節(jié)約41.51億元。結(jié)論:利用Markov模型模擬Hp感染到胃癌的自然病程,可以發(fā)現(xiàn)Hp根除治療可以有效減少感染人群中胃癌的發(fā)病率,降低人群死亡率。衛(wèi)生經(jīng)濟(jì)學(xué)方面,根除治療后,Hp感染導(dǎo)致的胃癌直接相關(guān)的費(fèi)用也相應(yīng)地減少。因此,在Hp感染人群中,包括無癥狀的感染者中,推薦進(jìn)行根除治療。
[Abstract]:Background & objective: gastric cancer is the only tumor directly related to bacterial infection in human diseases. Helicobacter pylori (HP) is a carcinogenic pathogen with a prevalence rate of 50%. Whether eradication treatment should be carried out remains controversial. From the point of view of health economics and population level, this study compared the effect and cost difference of eradication therapy in patients with HP infection, and provided a new decision-making idea for the medical service of asymptomatic infection population. Methods: Markov cohort model was used to estimate the long-term effect and cost of HP eradication therapy in eradication group and non-eradication therapy in control group. The parameters of the model were obtained from published literature and authoritative websites. The direct indexes included the distribution of each state and the incidence of gastric cancer, the average life year, the average quality adjusted life year, the average total cost and the average cost of gastric cancer treatment. Incremental analysis mainly refers to the increased or decreased cost per additional life year and the increased or reduced cost per additional treatment adjusted life year. Finally, the benefit of population level in Zhejiang Province is estimated by combining relevant data of Zhejiang Province. Results: during the whole study, the incidence of gastric cancer in the eradication group was always less than that in the control group, and the cumulative mortality rate in the eradication group (55.70%) was lower than that in the control group (65.29%) (P0.01). In the eradication group, about 280000 life years and 260000 quality-adjusted life years were accumulated, and the total direct cost for gastric cancer was about 285.77 million yuan. In the control group, about 260000 life years and 210000 quality-adjusted life years were accumulated, and the total direct cost for gastric cancer was about 358.53 million yuan. Incremental analysis found that each extension of one life year at the same time can save 3318.18 yuan of related medical expenses, each extension of a quality adjustment life year at the same time can reduce 1428.57 yuan of related medical expenses. The case study shows that eradication therapy for 40 years old people with HP positive in Zhejiang province can not only effectively reduce the number of gastric cancer, but also prolong the cumulative life years of 125.27 million and 2.912 million quality-adjusted life years in comparison with the non-eradication treatment. By reducing the number of deaths by 54700, you can save a total of 4.151 billion yuan. Conclusion: using Markov model to simulate the natural course of HP infection into gastric cancer, it can be found that HP eradication therapy can effectively reduce the incidence of gastric cancer and reduce the mortality of the population. In terms of health economics, the cost of gastric cancer directly associated with HP infection after eradication has been reduced accordingly. Therefore, eradication therapy is recommended in people with HP infection, including asymptomatic infections.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.2
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本文編號(hào)：2121155