社区人群结直肠癌机会性筛查的成本效果分析

Cost-effectiveness of Opportunistic Screening for Colorectal Cancer in Community Population

目的评价社区人群结直肠癌机会性筛查的成本效果。方法对2013年4—7月在中国航天科工集团七三一医院体检中心进行健康体检的某单位在职及退休职工5 270名进行结直肠癌机会性筛查,测算筛查成本和效果,进行成本效果分析。结果初筛人群中,结直肠肿瘤危险因素量表调查问卷(QA)顺应性为100.00%(5 270/5 270),阳性率为11.95%(630/5 270);免疫法粪便隐血试验(IFOBT)顺应性为83.91%(4 422/5 270),阳性率为2.28%(101/4 422);共筛查出666例高危人群(QA和IFOBT任意一项阳性者),阳性率为12.64%(666/5 270)。高危人群中,有202例接受了结肠镜检查,顺应性为30.33%(202/666)。结肠镜检查发现结直肠癌3例,检出率为1.49%(3/202);癌前病变(腺瘤性息肉)45例,检出率为22.28%(45/202)。初筛出1例高危人群的平均成本为55.95元,筛查出1例癌前病变的平均成本为2 612.88元,筛查出1例结直肠癌的平均成本为39 193.13元。结论社区人群结直肠癌机会性筛查顺应性好,是经济和有效的,适合大范围推广。

Objective To evaluate the cost effectiveness of opportunistic screening for colorectal cancer in community population. Methods From April to July in 2013,we conducted opportunistic screening for colorectal cancer on 5 270 in -service or retired staffs of an institution who received physical examination in No. 731 Hospital of CASIC. The cost and effectiveness of screening was measured,and cost -effectiveness analysis was conducted. Results Among the subjects,the compliance to colorectal cancer risk factor scale （ QA ） was 100. 00%（ 5 270/5 270 ）, and the positive rate was 11. 95%（630/5 270）;the compliance to immune fecal occult blood test（IFOBT）was 83. 91%（4 422/5 270）,and the positive rate was 2. 28%（101/4 422）;a total of 666 subjects with high risk for colorectal cancer were found（with either QA positive or IFOBT positive）,and the positive rate was 12. 64% （666 /5 270）. Among high - risk subjects,202 subjects received colonoscopy examination with a compliance of 30. 33% （ 202/666 ）. We found 3 cases of colorectal cancer by colonoscopy examination,with a detection rate of 1. 49%（3 /202）;we detected 45 cases of precancerous lesions（adenomatous polyp）with an detection rate of 22. 28%（ 45/202 ） . The average screening cost for one case of high risk for colorectal cancer was 55. 95 yuan,the average screening cost for one case of precancerous lesions was 2 612. 88 yuan,and the average cost for one case of colorectal cancer was 39 193. 13 yuan. Conclusion The opportunistic screening for colorectal cancer in community population is effective and economical with high screening compliance,thus it is suitable for widespread promotion.