农村社区门诊糖尿病筛查效果与成本效果分析

Cost-effectiveness analysis on diabetes screening among outpatients in rural community

目的:分析农村社区门诊糖尿病筛查效果和成本效果,为农村社区糖尿病筛查综合策略制定提供依据。方法:对某乡镇社区卫生服务机构1 639例年龄≥35岁门诊首诊病人进行问卷调查和糖尿病筛查,测算筛查成本、成本效果比和增量成本效果比。结果:年龄≥35岁门诊首诊病人糖尿病筛查成本为7 140.00元(中心和服务站分别为2 472.5元和4 667.5元),糖尿病患者检出率为1.2%(中心和服务站分别为2.2%和0.7%),成本效果比为375.79元/例(中心和服务站分别为291.72元/例、666.79元/例);随着筛查年龄切点的增高,筛查成本、成本效果比和增量成本效果比减小。结论:门诊首诊病人测血糖为农村社区糖尿病筛查提供经济、有效和可行的新途径,优先考虑45岁为筛查年龄切点。

Objective To analyze cost-effectiveness of diabetes screening among outpatients in rural community and to provide evidence for policy making on community-based integrated diabetes screening strategy in rural areas.Methods Totally 1 639 outpatients over 35 years old were investigated and screened in a rural community health service institute.Total costs,cost-effectiveness ratios and incremental cost-effectiveness ratio were calculated to compare different strategies.ResultsTotal direct costs of diabetes screening among outpatients over 35 years old were 7 140.00 RMB yuan（2 472.5RMB yuan for center and 4667.5RMB yuan for stations）.Overall detection rate of diabetes was1.2%（2.2%for center and 0.7% for stations）,and cost-effectiveness ratio was 375.79 RMB yuan（291.72 RMB yuan for center and 666.79 RMB yuan for stations）.Along with the cutoff value of screening age increased,total costs,cost-effectiveness ratios and incremental cost-effectiveness ratio decreased.Conclusions Diabetes screening among outpatients was cost-effective and feasible in rural community,and the cutoff value of 45 years old was a priority.