浙江省2013-2018年城市居民结直肠癌筛查结果及成本效果分析

Results and cost-effectiveness of colorectal cancer screening program among urban residents in Zhejiang province,2013-2018

目的综合评价浙江省城市居民结直肠癌筛查的结果和成本效果,为结直肠癌筛查策略的优化提供参考依据。方法基于2013-2018年浙江省开展的城市癌症早诊早治项目,分析40~74岁城市居民结直肠癌筛查参与率和病变检出率,采用χ2检验比较不同组间率的差异,采用logistic回归分析其影响因素。测算以检出1例病变的成本为指标的成本效果比。结果共完成问卷调查166285名,评估为结直肠癌高危人群21975名(13.2%),其中4389名接受了结肠镜检查,依从率为20.0%,共检出结直肠癌11例(检出率为0.3%)、进展期腺瘤119例(2.7%)和非进展期腺瘤229例(5.2%)。多因素logistic回归分析显示,性别、年龄、文化程度、吸烟、饮酒、类便隐血检测史、肠息肉疾病史和结直肠癌家族史与肠镜依从率显著相关;年龄、吸烟史、肠息肉病史与结直肠进展期病变(癌和进展期腺瘤)检出率有关。成本效果分析结果显示,筛查检出1例进展期病变的成本为22355.74元,其中检出1例结直肠癌的成本达264204.18元;年龄组越大,成本效果比越小;敏感性分析提示提高肠镜依从率可降低成本效果比。结论当前筛查项目有助于发现结直肠癌前病变,但结肠镜依从性相对较低,限制了筛查整体效果和经济学收益,应进一步加强高危人群肠镜检查的组织动员工作。

Objective To analyze the results and cost-effectiveness of colorectal cancer(CRC)screening program among Zhejiang urban residents so as to provide evidence for further optimization of CRC screening strategies.Methods Based on the Cancer Screening Program in Urban China which was conducted in Zhejiang province from 2013-2018,data related to the rates on compliance and detection through the CRC screening program among the 40-74 year-old residents were analyzed.Chi-square tests were used to compare the differences among groups,and multivariate logistic regression models were applied to explore the potential risk factors.Cost-effectiveness ratio(CER)was calculated by using the cost per lesion detected as the indicator.Results Among all the 166285 participants who completed the risk assessment questionnaire,21975(13.2%)were recognized as under the high risk of CRC and 4389(20.0%)of them received the colonoscopy.The detection rates of CRC,advanced adenoma,and non-advance adenoma were 0.3%(11 cases),2.7%(119 cases),and 5.2%(229 cases),respectively.Results from the multivariate logistic regression analyses showed that factors as age,gender,education level,smoking,drinking alcohol,previous fecal occult blood test(FOBT),polyp history,and family history of CRC were significantly associated with the compliance rate of colonoscopy while age,smoking and polyp history were significantly associated with the detection rate of advanced neoplasms(CRC and advanced adenoma).The costs were￥22355.74 Yuan for every CER advanced neoplasm detection and￥264204.18 Yuan per CRC detection,respectively.The CER decreased along with ageing.Sensitivity analysis showed that CERs were expected to decrease when the compliance rate of colonoscopy was increasing.Conclusions The current screening program seems effective in detecting the precancerous colorectal lesions,but the relatively low compliance rate of colonoscopy restricting both the diagnostic yields and economic benefits.It is necessary to improve the awareness and acceptance of colonoscopy among the high-risk CRC population.