上消化道癌筛查卫生经济学评价研究进展

Progress in health economic evaluation of upper gastrointestinal cancer screening

目的上消化道癌筛查已成为降低上消化道癌死亡率、提高生存率的主要策略,而综合的卫生经济学评价可为卫生决策者确定筛查方案提供重要参考。本文对常见的卫生经济学评价方法及其在上消化道癌筛查中的应用现状进行分析和总结。方法以"上消化道癌、食管癌、胃癌筛查,成本-效果、卫生经济学评价"等作为中文关键词,以"upper gastrointestinal cancer、esophageal cancer、gastric cancer、screening、cost、effectiveness、health economic evaluation"等作为英文关键词,检索PubMed、中国知网和万方数据库2000-01-01-2019-08-31发表的相关文献,共检索到中文文献344篇,英文文献476篇。纳入标准:(1)卫生经济学评价方法;(2)上消化道癌筛查的卫生经济学评价研究。根据纳入标准分析文献30篇(中文23篇,英文7篇)。结果对上消化道癌筛查进行卫生经济学评价有助于筛查方案的选择和筛查人群的确定以及合理配置卫生资源;大多数的卫生经济学评价研究是针对上消化道癌高发区筛查进行的,其他地区有待探讨;大部分的研究并未考虑质量调整生命年(quality-adjusted life year,QALY)这一指标;进行卫生经济学评价的数据多是患者就医时的费用,而不是医疗成本。结论可通过进行综合的卫生经济学评价来探索适合不同地区、具有地方特色和科学的上消化道癌筛查方案,从而更合理地分配卫生资源,使社会效益和经济效益最大化。

OBJECTIVE Screening for upper gastrointestinal cancer has become the main strategy to reduce the mortality of upper gastrointestinal cancer and improve survival rate.Comprehensive health economic evaluation can provide an important reference for health decision-makers to determine screening programs.This paper analyzed and summarized the common health economic evaluation methods and their application status in upper gastrointestinal cancer screening.METHODS With"upper gastrointestinal cancer,esophageal cancer,gastric cancer,screening,cost,effectiveness,health economic evaluation"as the keywords,a total of 344 Chinese literatures and 476 English literatures were retrieved from relevant literatures published on PubMed,CNKI and Wanfang database 2000-01-01-2019-08-31.The exclusion criteria:(1)Health economics evaluation method;(2)Health economic evaluation research of upper gastrointestinal cancerscreening.According to the inclusion criteria,30 articles were analyzed(23 in Chinese and 7 in English).RESULTS Health economic evaluation of upper gastrointestinal cancer screening is helpful for screening program selection and screening population determination and rational allocation of health resources.Most health economic evaluation studies are aimed at screening high-risk areas of upper gastrointestinal cancer.Other areas are yet to be explored.Most of the studies do not consider the QALY indicator.The data for health economic evaluation are mostly the cost of patients when they seek medical care,not medical costs.CONCLUSIONS Through the use of comprehensive health economic evaluation,we can explore scientific upper-level gastrointestinal cancer screening programs suitable for different regions and localities,so as to allocate health resources more rationally and maximize social and economic benefits.