以医院为基础的结直肠癌筛查策略卫生经济学评价研究

Health Economics Evaluation on Hospital-Based Colorectal Cancer Screening Strategies

目的:从卫生经济学角度探索结直肠癌筛查的成本-效果和成本-效益,为卫生健康行政部门决策提供科学依据。方法:随机选取样本医院975名年龄在40~75岁的医院就诊人群,开展结直肠癌风险评估问卷初筛后序贯便潜血+肠镜检测、肠镜检测和多靶点粪便DNA联合检测等3种复筛策略,评价筛查的成本-效果和成本-效益。结果:多靶点DNA联合检测总体阳性率为26.32%,肠镜依从率为48.00%;便潜血检测总体阳性率为29.25%,肠镜依从率为67.74%。男性多靶点粪便DNA检测阳性率高于女性(P=0.017);随年龄增长,DNA检测阳性率呈上升趋势(P=0.004)。平均每发现1例腺瘤性病变和大肠癌的成本分别为7 482.27元和30 652.18元。采用MT-sDNA、结肠镜、便潜血+肠镜检测复筛方法的效益成本比分别为9.20、9.62和9.61。结论:多靶点粪便DNA检测可用于具有较高支付意愿的人群开展机会性筛查。结直肠癌风险评估问卷初筛序贯便潜血检测复筛方法具有较高的成本-效益。

Objective:To explore the cost-effectiveness and cost-benefit of colorectal cancer(CRC) screening from the perspective of health economics,so as to provide scientific basis for decision-making by health administrative departments.Methods:A total of975 hospital patients aged 40-75 years were randomly selected to evaluate the cost-effectiveness and cost-effectiveness of CRC risk assessment questionnaire followed by sequential fecal occult blood plus colonoscopy,colonoscopy and MT-sDNA combined detection.Results:The overall positive rate of multi-target DNA detection was 26.32%,and the compliance rate of colonoscopy was 48.00%.The overall positive rate of fecal occult blood test was 29.25%,and the compliance rate of colonoscopy was 67.74%.The positive rate of MT-sDNA in males was higher than that in females(P=0.017).The positive rate of DNA detection increased with age(P=0.004).The average cost per case of adenomatous lesions and colorectal cancer was 7 482.27 yuan and 30 652.18 yuan,respectively.The benefit-to-cost ratios of MT-sDNA,colonoscopy and fecal occult blood+colonoscopy were 9.20,9.62 and 9.61,respectively.Conclusion:The multi-target fecal DNA test could be used for opportunistic screening of people with high willingness to pay.Through the CRC risk assessment questionnaire screening,sequential fecal occult blood test screening method had higher cost-effectiveness.