广东某地基于超声检查乳腺癌三级筛查模式实证研究

Empirical research of three-level breast cancer screening and diagnosis mode based on ultrasound examination in somewhere of Guangdong province

目的科学评价基于超声检查的乳腺癌三级筛查模式,为乳腺癌筛查项目提供实证证据。方法于2014年选择广东省2个地区35~64岁农村户籍女性进行筛查,以从化区、增城区作为试点地区、对照地区,各覆盖6个行政村,分别采用基于超声检查的乳腺癌三级筛查诊断模式和常规机会性筛查模式开展筛查,通过测算两种模式的筛查成本和效果指标进行成本效果评价,建立Markov模型进行成本效用分析,并对相关变量进行敏感性分析。结果共筛查48688名35~64岁农村女性,试点地区和对照地区分别筛查25055名和23633名,乳腺癌检出率分别为91.8/10万和29.6/10万,早诊率分别为47.8%(11/23)和28.6%(2/7)。55~64岁年龄层的检出率最高,45~54岁次之,35~44岁最低。试点地区和对照地区每提升1/10万的乳腺癌检出率分别需要花费1.6万元和3.7万元,试验地区比对照地区提升1/10万的乳腺癌检出率需要多花费0.6万元,成本效果比更低,效率更高,投入的成本更具价值。在随后30年内,相比常规模式,三级筛查诊断模式每筛查10万名女性,将减少发生60例乳腺癌,多获得870个生命年和965个质量调整生命年。结论基于超声检查的乳腺癌三级筛查诊断模式可提高农村地区女性乳腺癌的检出率和早诊率,成本效果和成本效用好。

Objective To scientifically evaluate the three-level breast cancer screening and diagnosis mode based on ultrasound examination,and to provide empirical evidences for breast cancer screening projects.Methods Thirty-five to sixty-four years old female villagers were selected from six administrative villages in the pilot area,including Conghua and Zengcheng,and from six administrative villages in the control area in Guangdong;and three-level breast cancer screening and diagnosis mode based on ultrasound examination and conventional opportunistic screening mode were used for screening.By measuring the costs and effect indicators of these two modes,the cost-effectiveness was evaluated.Markov model was established for cost-effectiveness analysis.A sensitivity analysis was performed to assess the robustness.Results A total of 48688 rural women aged 35-64 were screened,including 25055 in the pilot area and 23633 in the control area;the detection rates of breast cancer were 91.81/100000 and 29.62/100000,and the early diagnosis rates were 47.8%and 28.6%,respectively.The detection rate of the 55-64 age group was the highest,followed by those of the 45-54 age group and the 35-44 age group.It costs 16 thousand yuan and 37 thousand yuan as the breast cancer detection rate increases 1/100000 in the pilot and control areas,respectively.As the detection rate increases 1/100000 more in the pilot area than in the control area,it costs 6 thousand yuan,with a lower cost-effectiveness ratio and higher efficiency,so the cost of investment is more valuable.In the next 30 years,the three-level breast cancer screening and diagnosis mode will reduce 57 cases breast cancer in every 100000 women,and gain 872 life years and 966 quality-adjusted life years more than the routine mode.Conclusions Three-level breast cancer screening and diagnosis mode based on ultrasound examination can improve the detection rate and early diagnosis rate of breast cancer in rural areas.It has good cost-effectiveness and cost-utility,and is a screening mode suitable for rural areas in Guangdong Province.