基于马尔科夫链的社区脑卒中筛查性干预模式运行成效与成本效用分析  

The Effectiveness and Cost-Effectiveness Analysis of Community Stroke Screening Intervention Model Based on Mar-kov Model

作　　者：汤华山 吴依帆 曹贤 徐唐虎 马斌 冯雨 沈福来[3] 郑普阳 刘姣钰 Tang Huashan;Wu Yifan;Cao Xian;Ma Bin(Heqing Community Health Service Center,Pudong New Area,Shanghai,201201,China;不详)

机构地区：[1]上海市浦东新区合庆社区卫生服务中心,上海201201 [2]上海市社区健康研究小组,上海201201 [3]上海交通大学健康长三角研究院健康强基研究中心,上海201201

出　　处：《中国卫生经济》2024年第9期53-58,共6页Chinese Health Economics

基　　金：上海市浦东新区卫生健康委员会优势全科医学学科建设(PWYq2020-03)。

摘　　要：目的:探究社区人群脑卒中筛查性干预模式对脑卒中风险的影响及其成本效用。方法:本研究以3561例参与2017年、2019年、2021年筛查性干预的40岁以上社区人群为研究对象,将脑卒中风险分为低危、中危、高危3种状态,通过建立马尔科夫模型探究社区人群脑卒中筛查性干预模式对脑卒中风险的影响,并统计一期试验期间的成本增量,根据既往研究估算质量调整生命年增量,计算得成本效果增量比,对筛查性干预模式进行评价,并进行单因素敏感性分析。结果:在一定范围内,干预性筛查可有效使居民状态向低危方向转移,并最终稳定在低危47.4%、中危31.0%、高危21.6%的分布状态;干预性筛查增量成本为160245元,增量质量调整生命年为151.129,增量成本效果比(ICER)为1060.319元/QALY,小于1倍人均GDP,干预方案完全具有成本效果。结论:筛查性干预能够在预防阶段促进社区人群整体向脑卒中低危风险状态转变,且这一方式具有良好的成本效用表现。推荐尚不足以完全实行脑卒中社区预防、治疗、康复一体化流程服务的基层医疗卫生机构先实行小成本筛查性干预。Objective:To explore the impact and cost-effectiveness of community stroke screening intervention mode on stroke risk.Methods:A total of 3561 community people over 40 years old who participated in screening intervention in 2017,2019 and 2021 were selected as research objects,and stroke risk was divided into low risk,medium risk and high risk.A Markov model was established to explore the impact of screening intervention mode on stroke risk in community population.The cost increment during the phase I trial was calculated,and the life year increment was adjusted according to the quality estimate of previous studies.The cost-effectiveness increment ratio was calculated,and the screening intervention mode was evaluated,and univariate sensitivity analysis was performed.Results:Within a certain range,intervention screening could effectively shift the status of residents to the low-risk direction,and finally stabilize the distribution of low-risk,medium-risk and high-risk were 47.4%,31.0% and 21.6%.The incremental cost of interventional screening was 160245 yuan,the incremental quality-adjusted life year was 151.129 yuan,and the incremental cost-effectiveness ratio(ICER)was 1060.319 yuan/QALY,which was less than 1 times the per capita GDP.The intervention program was fully cost-effective.Conclusion:Screening intervention can promote the transformation of the commu-nity population to a low-risk state of stroke in the prevention stage,and this approach has good cost-effectiveness performance.It is recommended that the primary medical and health institutions that are not enough to fully implement the integrated process ser-vice of community prevention and treatment of stroke should first implement low-cost screening intervention.

关 键 词：脑卒中 成本效果分析 防治 马尔科夫模型 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] R197.1