在一般人群中对结直肠癌查的成本效益
A L Frazier1, G A Colditz, C S Fuchs
1Channing Laboratory, 181 Longwood Ave, Boston, MA 02115, USA. lindsay.frazier@channing.harvard.edu
JAMA
|October 18, 2000
概括
结肠直肠癌 (CRC) 查显著降低了死亡率,每年便隐性血液检测和每五年进行一次西格米多斯科普检查非常有效. 合规率极大地影响了成本效益,使得不完善的合规程度与不频繁的查相提并论.
科学领域:
- 卫生经济学 卫生经济学
- 预防医学 预防医学
- 在瘤学瘤学.
背景情况:
- 专家小组建议在50岁时对平均风险人群进行结肠直肠癌 (CRC) 查.
- 关于最佳CRC查策略存在不确定性.
研究的目的:
- 评估各种CRC查策略对平均风险个体的后果,成本和成本效益.
- 为了比较不同的查协议,包括专家小组推的.
主要方法:
- 从社会角度使用马尔科夫模型进行了成本效益分析.
- 这项研究模拟了美国的临床实践,对假设的50岁的个体进行了模拟,这些个体具有CRC的平均风险.
- 折扣的终身成本,预期寿命和增量成本效益 (CE) 比率为22种不同的CRC查策略计算.
主要成果:
- 每年进行再水化便隐性血液检测 (FOBT) 加上每5年进行一次西格莫视镜检查是白人男性最有效的策略,降低了60%的CRC发病率和80%的死亡率.
- 在百分之百的合规性下,每10年进行一次以上的查变得过于昂贵;在五年时间表中,百分之六十的合规性相当于在十年时间表中百分之百的合规性.
- 由于预期寿命和癌症死亡率的增加,CRC查在白人女性和黑人个人中被证明更具成本效益.
结论:
- 即使不完全遵守CRC查,也会大幅降低死亡率,其成本与其他癌症查相美.
- 合规率显著影响增量CE比率,强调需要将预期的合规性纳入临床指南的数学建模中.
- 与其他评估的策略相比,每年补水FOBT加上每5年进行一次西格莫镜检查显示出更高的成本效益.
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