肥城市上消化道癌筛查项目成本效果分析

Cost-effectiveness analysis of screening program for upper gastrointestinal cancer in Feicheng,Shandong Province

目的肥城市是我国首批上消化道癌筛查项目试点县市之一,2006年至今已完成8.3万余例上消化道癌筛查。本研究对2013-2017年肥城市上消化道癌筛查项目进行初步成本效果评价,以期为肥城市上消化道癌防治提供科学依据。方法采用整群随机抽样选取肥城市部分乡镇40~69岁人群,对其进行上消化道癌内镜碘染色筛查及指示性活检,计算阳性病例检出率、早诊率、治疗率等指标,收集项目筛查及病例诊断治疗环节各种成本,采用成本效果分析(cost-effectiveness analysis,CEA)进行评价,计算人均筛查成本、每减少1例上消化道癌死亡需投入的直接成本、发现早期病例费用和早期发现成本系数等指标。结果 2013-2017年肥城市共完成上消化道癌内镜筛查46 254例,确诊阳性病例981例,其中早期病例833例,治疗853例;病例检出率、早诊率和治疗率分别为2.12%、84.91%和86.95%。CEA显示,在肥城地区每多投入8 429元,即可减少1例上消化道癌死亡;平均每例受检者的筛查成本为472.72元;每检出1例阳性病例的成本为22 288.85元;每检出1例早期病例的成本为26 248.93元,以泰安市人均国内生产总值(gross domestic product,GDP)计算早期发现成本系数(early detection cost index,EDCI)为0.46。结论肥城市上消化道癌早诊早治项目成效显著,符合当地经济发展水平,具有良好的社会效益和经济效益。

OBJECTIVE Feicheng is one of the first counties in China to carry out screening programs for upper gastrointestinal cancer.Since 2006,more than 83 000 subjects have been screened in the program.This study aimed to evaluate the cost-effectiveness of screening program for upper gastrointestinal cancer in Feicheng,from 2013 to 2017,and to provide scientific information for the prevention and treatment of upper gastrointestinal cancer in the area.METHODS Endoscopy screening with iodine staining and indicative biopsy was conducted in target people aged 40-69 years who were selected by random cluster sampling method.The rates of positive detection,early diagnosis and treatment were calculated.The total cost of screening and treatment was collected,cost-effectiveness analysis(CEA)was used to assess the screening program.Numbers of deaths reduced,the cost per screening,the average early detection cost and the early detection cost index(EDCI)were used to evaluate the effect of CEA.RESULTS Totally 46 254 subjects were screened in the program during2013 to 2017.981 positive cases were diagnosed which included 833 early cases,and 853 were treated.The rates of positive detection,early diagnosis and treatment were 2.12%,84.91% and 86.95%,respectively.Data from CEA showed that each additional investment of 8 429 yuan can avoid one upper GI cancer death in Feicheng.The average screening cost for each subject was $472.72,and the average cost for one positive case detected was$22 288.85,while it was $26 248.93 for one early case.EDCI was 0.46 for GDP of Tai’an.CONCLUSION The screening program on upper gastrointestinal cancer in Feicheng has achieved remarkable effects,which is in line with the local economic development level and has good economical and social benefits.