中国自然人群筛查与伺机性检测策略预防幽门螺杆菌相关疾病的卫生经济学评价  

Health economic evaluation of Chinese population-based screening and opportunistic testing strategies to prevent Helicobacter pylori-related diseases

作　　者：陈琦 方颖 梁晓[2] 陆红[2] 沈锡中 Chen Qi;Fang Ying;Liang Xiao;Lu Hong;Shen Xizhong(Department of Gastroenterology and Hepatology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Gastroenterology and Hepatology,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200001,China)

机构地区：[1]复旦大学附属中山医院消化内科,上海200032 [2]上海交通大学医学院附属仁济医院消化内科,200001

出　　处：《中华消化杂志》2021年第4期234-240,共7页Chinese Journal of Digestion

基　　金：上海交通大学医学院多中心临床研究项目(DLY201608);上海市青年科技英才扬帆计划(19YF1428100)。

摘　　要：目的对H.pylori自然人群筛查和伺机性检测策略用于预防H.pylori相关疾病进行卫生经济学评价。方法建立H.pylori感染、非溃疡性消化不良、消化性溃疡(PU)、胃癌等状态的马尔可夫模型,模拟计算在我国10万自然人群中实施自然人群筛查、伺机性检测和无干预策略的成本和效果,对自然人群筛查和伺机性检测策略进行卫生经济学评价。统计学方法采用Wilcoxon符号秩检验。采用单因素敏感性分析单个参数不确定性对成本-效果的影响,采用概率敏感性分析所有参数的共同不确定性对成本-效果的影响。结果与伺机性检测策略和无干预策略相比,自然人群筛查策略的总成本分别减少了0.43百万元(-6.63百万元,7.19百万元)和4.45百万元(-8.60百万元,27.93百万元),质量调整生命年(QALY)生命年和无症状月分别延长了888.00个(479.86个,1574.10个)和3032.78个(1756.04个,5007.84个)、651.82个(294.73个,1211.94个)和1868.64个(1045.88个,3148.34个)、28381.91个(19109.54个,43736.72个)和102537.13个(58649.18个,176868.77个),胃癌发生、胃癌死亡、PU死亡和全因死亡分别减少了115例(52例,232例)和464例(266例,803例)、74例(33例,148例)和260例(149例,453例)、46例(25例,72例)和369例(210例,710例)、80例(42例,126例)和501例(331例,772例),差异均有统计学意义(Z=1.99、10.54、27.39、27.39、27.37、27.39、27.39、27.39、27.21、27.28、27.22、27.28、27.38、27.39、27.39、27.39,P均<0.05)。与无干预策略相比,伺机性检测策略的总成本减少了3.89百万元(-2.79百万元,18.18百万元),QALY、生命年和无症状月分别延长了1764.77个(888.70个,3406.62个)、1044.16个(524.46个,1912.75个)和62568.69个(30054.07个,129892.76个),胃癌发生、胃癌死亡、PU死亡和全因死亡分别减少了311例(164例,563例)、164例(87例,301例)、325例(162例,644例)和399例(234例,684例),差异均有统计学意义(Z=14.20、27.39、27.38、27.39、27.25、27.25�Objective To conduct health economic evaluation of Chinese population-based screening and opportunistic testing strategies for the prevention of Helicobacter pylori(H.pylori)-related diseases.Methods The Markov models of H.pylori infection caused non-ulcer dyspepsia,peptic ulcer(PU)and gastric cancer were established.The cost and effects of the population-based screening,opportunistic testing,and non-intervention strategies in 100000 population of our country were simulation calculated.Wilcoxon signed rank test was used for statistic analysis.Single factor sensitivity analysis was performed to analyze the impact of single parameter uncertainty on cost-effectiveness.Probability sensitivity was used to analyze the impact of common uncertainty of all parameters on cost-effectiveness.Results Compared with opportunistic testing strategy and non-intervention strategy,the total cost of population-based screening strategy was reduced by 0.43 million yuan(-6.63 million yuan to 7.19 million yuan)and 4.45 million yuan(-8.60 million yuan to 27.93 million yuan),quality adjusted life years(QALY),life years and asmptomatic months were prolonged by 888.00(479.86 to 1574.10)and 3032.78(1756.04 to 5007.84),651.82(294.73 to 1211.94)and 1868.64(1045.88 to 3148.34),28381.91(19109.54 to 43736.72)and 102537.13(58649.18 to 176868.77)respectively,gastric cancer,deaths from gastric cancer,deaths from PU and deaths from various causes were reduced by 115 cases(52 cases to 232 cases)and 464 cases(266 cases to 803 cases),74 cases(33 cases to 148 cases)and 260 cases(149 cases to 453 cases),46 cases(25 cases to 72 cases)and 369 cases(210 cases to 710 cases),80 cases(42 cases to 126 cases)and 501 cases(331 cases to 772 cases)respectively,and the differences were statistically significant(Z=1.99,10.54,27.39,27.39,27.37,27.39,27.39,27.39,27.21,27.28,27.22,27.28,27.38,27.39,27.39 and 27.39,all P<0.05).Compared with the non-intervention strategy,the opportunistic testing strategy reduced the total cost by 3.89 million yuan(-2.79 million yuan to 18.

关 键 词：幽门螺杆菌 自然人群筛查 伺机性检测 卫生经济学评价 马尔可夫模型 

分 类 号：R573[医药卫生—消化系统] R1[医药卫生—内科学]