全球肺癌筛查卫生经济学研究的系统评价  

Cost-effectiveness of lung cancer screening worldwide: a systematic review

作　　者：刘成成 石菊芳 刘国祥[2] 唐威 张歆[2] 李放 王乐 马祎[2] 苏凯 赵世俊 高亦博 李霓 陈万青 吴宁 代敏 Liu Chengcheng;Shi Jufang;Liu Guoxiang;Tang Wei;Zhang Xin;Li Fang;Wang Le;Ma Yi;Su Kai;Zhao Shijun;Gao Yibo;Li Ni;Chen Wanqing;Wu Ning;Dai Min(Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;School of Public Health, Harbin Medical University, Harbin 150086, China;Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院癌症早诊早治办公室,北京100021 [2]哈尔滨医科大学公共卫生学院,150086 [3]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院影像诊断科,北京100021 [4]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院胸外科,北京100021

出　　处：《中华流行病学杂志》2019年第2期218-226,共9页Chinese Journal of Epidemiology

基　　金：科技部重大慢性非传染性疾病防控专项(2017YFC1308705,2017YFC1308700);国家自然科学基金(81773521);国家重点研发计划(2017YFC0907901,2017YFC0907900,2018YFC1315000);中国医学科学院中央级公益性科研院所基本科研业务费青年医学人才奖励项目(2018RC330001).

摘　　要：目的了解全球肺癌筛查的卫生经济学评价研究进展,为我国相关研究和筛查工作开展提供参考。方法系统检索PubMed、EMbase、The Cochrane Library、中国知网及万方数据知识服务平台自建库至2018年6月30日间肺癌筛查卫生经济学研究相关文献,摘录其经济学评价方法及结果等信息,并进行质量评价。成本统一货币单位后计算增量成本效果比(ICER)后计算与当年当地人均GDP比值。结果共纳入23项研究(1项基于人群随机对照试验,20项完全基于模型评价),整体质量较好;22项来自发达国家,11项筛查起始年龄为55岁,18项目标人群考虑了吸烟史;评价的筛查技术全部涉及低剂量螺旋CT(LDCT),筛查频率以每年1次(17项)和终生1次(7项)居多。22项研究可获得与未筛查相比的ICER,其中17项研究报道的ICER低于3倍当年当地人均GDP。各有15项和7项研究可获得每年1次和终生1次的ICER,其中各有12项和7项支持其经济有效,且终生1次略优于每年1次;不同筛查起始年龄和吸烟包年的经济有效性优劣差异不明显。结论发达国家多开展基于模型LDCT肺癌筛查卫生经济学评价,并结合年龄和吸烟史进行高危人群选择,初步提示该方案经济有效;可为证据有限的欠发达地区提供参考,但实施需结合当地卫生资源现状;预算有限时低频次LDCT筛查更佳,而筛查起始年龄和吸烟史等细节确定需结合人群特征进行精准评价。Objective From the economic point of view, this study was to systematically assess the status quo on lung cancer screening in the world and to provide reference for further research and implementation of the programs, in China. Methods PubMed, EMbase, The Cochrane Library,CNKI and Wanfang Data were searched to gather papers on studies related to economic evaluation regarding lung cancer screening worldwide, from the inception of studies to June 30th, 2018. Basic characteristics, methods and main results were extracted. Quality of studies was assessed. Cost were converted to Chinese Yuan under the exchange rates from the World Bank. The ratio of incremental cost-effectiveness ratio (ICER) to local GDP per capita were calculated. Results A total of 23 studies (only 1 randomized controlled trial) were included and the overall quality was accepted. 22 studies were from the developed countries. Nearly half of the studies (11 studies) took 55 years old as the starting age of the screening program. Smoking history was widely applied for the selection of criteria on target populations (18). Low-dose computed tomography (LDCT) was involved in every study used to evaluate the economic effectiveness. Annual (17) and once-life time (7) screening were more common frequencies. 22 studies reported ICERs for LDCT screening, compared to no screening, of which 17 were less than 3 times local GDP per capita, and were considered as cost-effectiveness, according to the WHO’s recommendation. 15 and 7 studies reported ICERs for annual and once-life time screening, of which 12 and 7 studies were in favor the results of their cost-effectiveness, respectively. Additionally, the cost-effectiveness of once-lifetime screening was likely to be superior to the annual screening. Differences of cost-effectiveness among the subgroups, by starting age or by the smoking history, might exist. Conclusions Based on the studies, evidence from the developed countries demonstrated that LDCT screening programs on lung cancer, implemented among populatio

关 键 词：肺肿瘤 筛查 卫生经济学评价 系统评价 

分 类 号：R734.2[医药卫生—肿瘤] R1[医药卫生—临床医学]