上海市女性乳腺癌有组织筛查和机会性筛查的成本效果分析  

Cost-effectiveness analysis of two breast cancer screening modalities in Shanghai, China

作　　者：莫淼[1] 郑莹[4] 柳光宇[2] 方红[6] 张晓华 翟莲芳 陈英耀[5] 吕力琅[3] 朱洁如 罗剑锋[5] 张琳琳 曹志刚[3] 徐望红[5] 邵志敏[2] 

机构地区：[1]复旦大学上海医学院肿瘤学系复旦大学附属肿瘤医院临床统计中心,200032 [2]复旦大学上海医学院肿瘤学系复旦大学附属肿瘤医院乳腺外科,200032 [3]复旦大学上海医学院肿瘤学系复旦大学附属肿瘤医院院长办公室,200032 [4]上海市疾病预防控制中心肿瘤科 [5]复旦大学公共卫生学院教育部公共卫生安全重点实验室 [6]上海市闵行区疾病预防控制中心慢病科 [7]上海市闵行区妇婴保健院妇产科 [8]上海市闵行区七宝社区卫生服务中心妇幼保健科

出　　处：《中华肿瘤杂志》2015年第12期944-951,共8页Chinese Journal of Oncology

基　　金：美国中华医学基金会（China Medical Board）HPSS09-991项目

摘　　要：目的评价上海市闵行区开展的有组织筛查和机会性筛查两种乳腺癌筛查模式的成本效果。方法2008年5月至2010年10月，上海市闵行区分别开展了有组织的女性乳腺癌筛查（七宝社区）和机会性筛查（闵行部分医院和社区）。收集筛查成本、确诊患者的临床病理资料和首次住院治疗费用及间接费用，以闵行区未参加筛查的女性作为参照人群，比较筛查患者临床分期改善的平均成本，并计算增量成本效果。结果有组织筛查组、机会性筛查组和对照组分别报告了35、193和479例乳腺癌，早期乳腺癌所占的比例分别为46．9％、40．7％和38．9％。有组织筛查组和机会性筛查组人均筛查成本分别为208元和21元，每确诊1例患者的筛查成本分别为72453元和11640元。有组织筛查组患者的平均总成本为103650元，明显高于机会性筛查组的50712元和对照组的35413元，其中有组织筛查组患者首次住院直接医疗费用的中位数为11024元，明显低于机会性筛查组的13465元和对照组的14243元（P〈0．001）。有组织筛查组和机会性筛查组的平均额外成本分别为68237元和15299元。与对照组比较，有组织筛查和机会性筛查每获得1个单位分期提前所需成本分别为135291元和152179元；有组织筛查相对于机会性筛查每多获得1个单位分期提前所需增量成本为131086元。结论有组织筛查和机会性筛查模式均可早期发现乳腺癌，有组织筛查比机会性筛查的项目成本更高，但患者首次住院直接医疗费用较低，总体成本效果更好，可考虑在中国经济较发达地区的适龄女性人群中应用。Objective To evaluate the cost-effectiveness of two breast cancer screening modalities conducted in Minhang district of Shanghai, China. Methods An organized and an opportunistic breast screening programs were implemented among women aged 35-74 years in Minhang district of Shanghai between May 2008 and Oct 2010, and were compared with the results obtained without screening. Costs related to screening were obtained by access to finance data of the screening programs, and costs of first treatment were collected through patient survey and medical reimbursement system query. Information on breast cancer stage was obtained from Shanghai Cancer Registry and confirmed by medical chart review. The effectiveness of screening was evaluated by breast cancer stage improvement. Cost-effectiveness ratios （CERs） were computed as costs of gaining a stage improvement from a specified screening strategy when compared with the results obtained without screening. Incremental cost-effectiveness （ICER） which compares the two screening strategies was calculated by dividing the difference in total net costs and the difference in stages improved between the two screening strategies. Results Thirty-five, one hundred and ninety-three and four hundred and seventy-nine breast cancer cases were identified in the organized screening, opportunistic screening and control groups, with an early detection rate of 46.9%, 40.7% and 38.9%, respectively. The costs of screening were 208 yuan per person or 72 453 yuan per case detected in the organized screening group and were 21 yuan per person or 11 640 yuan per case detected in the opportunistic screening group. The total cost was 103 650 yuan per case in the organized screening group, significantly higher than 50 712 yuan in the opportunistic screening group and 35 413 yuan in the control group. However, the average direct medical cost was significantly lower in the organized screening group than that in the opportunistic screening group and control group, with median costs of 11 024 yuan, 13

关 键 词：乳腺肿瘤 筛查 成本及成本分析 

分 类 号：R737.9[医药卫生—肿瘤]