基于社区的乳腺癌筛查成本预测与控制研究

Estimate and Control of the Cost of Community-based Breast Cancer Screening

目的探讨基于社区的乳腺癌筛查成本预测与控制,为政府制定相关卫生补偿机制提供依据。方法从社会学角度出发,预测基于社区的乳腺癌筛查方案(方案A)的筛查成本,并将其与2009年美国预防服务工作组(USPSTF)乳腺癌筛查推荐方案及其调整筛查年龄段后的筛查方案(方案B1、B2)、2010年我国农村妇女乳腺癌筛查推荐方案及其调整筛查年龄段后的筛查方案(方案C1、C2)进行比较。采用Treeage Pro 2011软件对基于社区的乳腺癌筛查方案的影响因素进行单因素敏感度分析。结果 5种筛查方案的筛查方法实施成本分别为1 396.67、7 988.73、14 643.52、3 866.84及4 643.26万元;项目管理成本分别为1 444.66、785.46、1 449.45、1 210.53及1 453.74万元;筛查对象相关成本分别为2 454.84、3 410.67、6 251.84、6 756.10、8 112.63万元;总成本分别为5 296.17、12 184.86、22 344.81、14 209.63及11 833.47万元;人均乳腺癌筛查成本分别为18.44、77.75、77.78、49.46及49.47元/人。单因素敏感度分析显示,钼靶X线摄影仪折旧维修费、全科医生年劳务费、单位乳腺触诊检查时间、乳腺触诊检查后建议钼靶X线摄影率、单位钼靶X线摄影时间对筛查成本的影响较大。结论基于社区的乳腺癌筛查的总成本和人均筛查成本均低于其他4种筛查方案,钼靶X线摄影仪折旧维修费和全科医生年劳务费是筛查成本的主要构成。选择高效、低价、耐用的筛查设备,提高其利用率和完好率,强化人员培训,合理控制检查时间,提高劳动效率是乳腺癌筛查成本控制的重要内容。

Objective To study the estimate and control of the cost of community-based breast cancer screening,in order to provide references for making the mechanism of health care reimbursement by government. Methods The cost of community-based breast cancer screening scheme （ scheme A ） was estimated from the perspective of sociology and was compared with that of the breast cancer screening scheme recommended by USPSTF in 2009（scheme B1）,the adjusted version of scheme B1 adjusted by age（scheme B2）,China rural breast cancer screening scheme recommended in 2010（scheme C1） and the adjusted version of scheme C1 adjusted by age（scheme C2）. Treeage Pro 2011 software was employed to conduct single-factor sensitivity analysis of the influencing factors for community-based breast cancer screening. Results The implementation cost of the five schemes was 13 966. 7,79 887. 3,146 435. 2,38 668. 4 and 46 432. 6 thousand yuan respectively;the scheme management cost was 14 446. 6,7 854. 6,14 494. 5,12 105. 3 and 14 537. 4 thousand yuan respectively;the relevant cost of screening objects was 24 548. 4,34 106. 7,62 518. 4,67 561. 0,81 126. 3 thousand yuan;the total cost was 52 961. 7, 121 848. 6,223 448. 1,142 096. 3,and 118 334. 7 thousand yuan respectivey. The average cost of breast cancer screening per person was 18. 44,77. 75,77. 78,49. 46 and 49. 47 yuan respectively. The single - factor sensitivity analysis showed that depreciation and maintenance cost of molybdenum target X-ray camera,the yearly cost of general practitioners,the mammary＆nbsp;gland palpation and inspection time per person,the rate of molybdenum target X-ray photography recommended after mammary gland palpation and inspection and the unit time of molybdenum target X-ray photography have significant influences on the cost of screening. Conclusion The general cost and the cost per person of community-based breast cancer screening are lower than other four schemes,and depreciation and maintenance cost of molybdenum target X-ray camera and the yearly cost of general practitioners are the major constitutes of the screening cost. Applying high - efficiency, low - price and durable screening equipments,improving the equipments＇ usage rate and serviceability rate, strengthening personnel training, controlling inspection time rationally,improving the efficiency of labor are the major contents of the cost control of breast cancer screening.