筛查幽门螺杆菌预防胃癌的Markov模型卫生经济学评价  

Cost-effectiveness of Helicobacter pylori screening to prevent gastric cancer: Markov decision analysis

作　　者：王倩[1] 林果为[1] 金丕焕[2] 陈洁[3] 徐三荣[4] 

机构地区：[1]复旦大学附属华山医院临床流行病学培训中心,上海200040 [2]复旦大学公共卫生学院卫生统计教研室 [3]复旦大学公共卫生学院医院管理教研室 [4]复旦大学附属华山医院消化内科

出　　处：《中华流行病学杂志》2003年第2期135-139,共5页Chinese Journal of Epidemiology

摘　　要：目的　评价人群中筛查幽门螺杆菌 (Hp)感染预防胃癌的干预措施。 方法　用Markov模型MonteCarlo分析法估计筛查的远期效果和费用 ,并进行增量分析。结果　当根治Hp感染能减少胃癌发生的有效率为 50 %时 ,在 30～ 40岁的人群中进行一次性筛查Hp感染并治疗阳性者可减少1 6 .6 %的胃癌发生 ,每减少一例胃癌的费用为 1 0 4 0 5元 (95 %CI:42 38～ 2 772 7元 ) ,每增加一个质量调整生命年所增加的费用为 64元 (95 %CI:31～ 97元 ) ,每延长一个生命年所增加的费用为 1 374元(95 %CI:352～ 86 62 4元 )。结论　筛查Hp感染能减少部分胃癌的发生 ,在胃癌高发区筛查的效果更好 。Objective Using Markov model Monte Carlo simulation to conduct a cost effectiveness analysis of screening Helicobacter pylori (H.pylori) infection to prevent gastric cancer.Methods The Markov model was developed based on the natural course from H.pylori infection to gastric cancer. Two strategies were compared:①screening for H.pylori and treatment for those with positive tests, and ②without screening and treatment. Data used for model simulation including transition probability, efficacy of test and treatment were collected from related research publications. Markov model Monte Carlo simulation combined with bootstrap method was used to perform base case analysis and estimate the confidence interval of cost effectiveness ratios. The probability sensitivity analysis was used to estimate the cost effectiveness in multiple uncertainty factors. Results Assuming H.pylori eradication will prevent 50% of attribute gastric cancer, the screening strategies would prevent 16.6 % cases of gastric cancer. Cost effectiveness were 10 405 Yuan (95% CI : 4 238 27 727 Yuan) per GC prevented, 64 Yuan (95% CI : 31 97 Yuan) per QALY saved and 1 374 Yuan (95% CI :352 86 624 Yuan) per life year saved.Conclusion Screening and treatment for H.pylori infection in population was potentially effective in the prevention of gastric cancer,and screening in high incidence area of gastric cancer would be more effective and economic.

关 键 词：幽门螺杆菌 预防 胃癌 MARKOV模型 卫生经济学 

分 类 号：R735.2[医药卫生—肿瘤]