利用Markov模型进行胃癌高危人群胃镜监测的成本效果评价

A cost-effectiveness analysis evaluating endoscopic surveillance for high-risk population of gastric cancer using Markov model

目的:应用Markov模型对假设40岁胃癌高危人群(10 000人)进行不同胃镜监测随访策略间的成本效果分析,探索当前经济水平下对胃癌高危人群进行长期胃镜监测随访的最优策略。方法:考虑胃部不同疾病状态进展比例,模拟10 000例胃癌高危患者,评估2种随访策略:每年筛查一次的胃镜监测、每2 a筛查一次的胃镜监测。通过建立合适的Markov模型建立高危到胃癌发生的各种状态,以每1 a为周期计算出成本、效果,循环30 a后,计算出3种策略的增量成本效果比(ICER)进行比较,并通过敏感性分析评价参数对模型稳定性的影响。结果:每年筛查一次策略、每2 a筛查一次策略与不筛查策略相比分别减少了胃癌死亡人数381、193例。每年筛查一次策略与不筛查策略相比增加4 835.20个质量调整寿命年(QALY),其ICER为22 758.41元/QALY。每2 a筛查一次策略与不筛查策略相比增加2 509.20个QALY,其ICER为21 974.07元/QALY。结论:在支付意愿为52 000元时,对40岁人群进行每年筛查一次或每2 a筛查一次监测策略均为有成本效果,最优策略为每年筛查一次。

Aim： To explore the optimal strategies for long-term monitoring of gastric cancer by evaluating the cost-effectiveness of gastroscopy surveillance in high-risk population of gastric cancer aged 40 years using Markov model at the present economic level. Methods： Using a reference strategy of no gastroscopy intervention,simulation of 10 000 high-risk patients with gastric cancer was set,and two strategies were evaluated： annual gastroscopy surveillance and 2-yearly gastroscopy surveillance. By collecting the state transition probabilities,Markov models were built to simulate the life experience of the target population. The models projected lifetime costs,quality adjusted life year（ QALY）,and incremental costeffectiveness ratio（ ICER） indicating the cost-effectiveness of each strategy. Sensitivity analysis was used to quantify the influence of parameter uncertainties. Results： Annual gastroscopy surveillance could respectively extend the lives of cohort4 835. 20 QALY than no gastroscopy surveillance,and the ICER was 22 758. 41 Yuan/QALY,respectively. 2-yearly gastroscopy surveillance could extend 2 509. 20 QALY than no gastroscopy surveillance,and the ICER was 21 974. 07 Yuan/QALY. Conclusion： With the willingness-to-pay of 52 000 Yuan/QALY,the annual gastroscopy surveillance and 2-yearly gastroscopy surveillance both are cost-effective in the prevention of gastric cancer for high-risk population of gastric cancer aged 40 years. The annual gastroscopy surveillance is the optimal strategy.