广州市大东街2015—2019年大肠癌人群筛查及伺机性筛查效果及成本效益分析  

Cost-effectiveness of colorectal cancer screening between mass screening and opportunistic screening in Dadong street community of Guangzhou,2015-2019

作　　者：田唤 苏启英 袁茂华 黄瑾 赵德坚[2] 罗思敏 万德森[3] 方淯靖[3] TIAN Huan;SU Qi-ying;YUAN Mao-hua;HUANG Jin;ZHAO De-jian;LUO Si-min;WAN De-sen;FANG Yu-jing(Dadong Street Community Health Service Center,Guangzhou 510080,Guangdong,China;不详)

机构地区：[1]广州市越秀区大东街社区卫生服务中心,广东广州510080 [2]广州市越秀区疾病预防控制中心,广东广州510055 [3]中山大学肿瘤防治中心、华南肿瘤学国家重点实验室、肿瘤医学协同创新中心结直肠科,广东广州510060

出　　处：《广东医学》2021年第6期742-744,F0003,共4页Guangdong Medical Journal

基　　金：广州市卫生健康科技项目(20191A011110);广州市科技计划项目—健康医疗协同创新重大计划(201803040019)。

摘　　要：目的依据广州市越秀区大东街2015—2019年大肠癌筛查数据,分析人群筛查和伺机筛查的筛查效果,并从经济学角度分析大肠癌筛查的经济和社会效益,为下一轮大肠癌筛查提供建议。方法利用统计学分析和χ^(2)检验分析人群筛查和伺机筛查的结果,利用成本效益分析测定筛查的直接成本、直接效益和间接效益,计算筛查净效益及效益成本比。结果伺机性筛查的阳性率明显高于人群筛查(χ^(2)=42.43,P<0.01),两组间肠镜顺应性差异无统计学意义(χ^(2)=2.61,P=0.11)。在检出肠道病变方面,伺机筛查大肠癌(3.5%)及进展期腺瘤(18.4%)的检出率高于人群筛查中大肠癌(1.1%)及进展期腺瘤(9.6%)的检出率。本轮筛查净效益880.7万元,人群筛查效益成本比为6.4,伺机性筛查的效益成本比为9.3。结论大肠癌筛查可以降低医疗成本,伺机性筛查比人群筛查具有成本效益优势。Objective To analyze the results and economic and social benefits of colorectal cancer screening based on the colorectal cancer screening data in Dadong street community,Guangzhou City from 2015 to 2019,and to provide the theoretical basis of colorectal cancer screening.Methods The results of mass screening and opportunistic screening were analyzed.The direct costs,direct and indirect benefits of colorectal cancer screening were measured and estimated.The cost effectiveness,net benefit and cost-effectiveness ratio were calculated.Results The positive rate of opportunistic screening was significantly higher than mass screening(χ^(2)=42.43,P<0.01).There was no difference in participation rate of colonoscopy between mass screening and opportunistic screening(χ^(2)=2.61,P=0.11).The detection rates of colorectal cancer(3.5%)and advanced adenoma(18.4%)in opportunistic screening were higher than the detection rates of colorectal cancer(1.1%)and advanced adenoma(9.6%).The colorectal cancer screening net benefit was 8807000 RMB,the benefit cost ratio of mass screening was 6.4,and the benefit cost ratio of opportunistic screening was 9.3.Conclusion The colorectal cancer screening can reduce medical costs.Opportunistic screening has a cost-effective advantage over mass screening.

关 键 词：大肠癌筛查 人群筛查 伺机性筛查 效果 成本效益分析 广州 

分 类 号：R735.3+4[医药卫生—肿瘤] R194.3[医药卫生—临床医学]