利用Markov模型進行胃癌高危人群胃鏡監(jiān)測的成本效果評價
發(fā)布時間：2019-01-15 23:40
【摘要】：目的:應(yīng)用Markov模型對假設(shè)40歲胃癌高危人群(10 000人)進行不同胃鏡監(jiān)測隨訪策略間的成本效果分析,探索當(dāng)前經(jīng)濟水平下對胃癌高危人群進行長期胃鏡監(jiān)測隨訪的最優(yōu)策略。方法:考慮胃部不同疾病狀態(tài)進展比例,模擬10 000例胃癌高�；颊�,評估2種隨訪策略:每年篩查一次的胃鏡監(jiān)測、每2 a篩查一次的胃鏡監(jiān)測。通過建立合適的Markov模型建立高危到胃癌發(fā)生的各種狀態(tài),以每1 a為周期計算出成本、效果,循環(huán)30 a后,計算出3種策略的增量成本效果比(ICER)進行比較,并通過敏感性分析評價參數(shù)對模型穩(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QALY,其ICER為21 974.07元/QALY。結(jié)論:在支付意愿為52 000元時,對40歲人群進行每年篩查一次或每2 a篩查一次監(jiān)測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)計學(xué)教研室;
【基金】：江蘇省科技廳社會發(fā)展項目BE2011647
【分類號】：R735.2
本文編號：2409231
[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)計學(xué)教研室;
【基金】：江蘇省科技廳社會發(fā)展項目BE2011647
【分類號】：R735.2
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1 王倩 ,林果為 ,金丕煥 ,陳潔 ,徐三榮;篩查幽門螺桿菌預(yù)防胃癌的Markov模型衛(wèi)生經(jīng)濟學(xué)評價[J];中華流行病學(xué)雜志;2003年02期
，本文編號：2409231
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