结直肠癌筛查卫生经济学评价研究进展

Research progress in health economic evaluation of colorectal cancer screening

目的系统梳理结直肠癌筛查经济学评估证据和最新研究进展,为优化结直肠癌筛查提供经济学依据。方法检索中国知网、万方知识服务平台、维普中文科技期刊数据库、PubMed、Embase、Cochrane和Web of Science数据库自建库至2022-04-01发表的相关文章,中文数据库以卫生经济学评价、卫生经济学评估、成本-效果分析、成本-效用分析、成本-效益分析、最小成本分析、成本分析与结直肠癌,结直肠肿瘤与筛查为关键词进行组合;英文数据库以economic evaluation、economics analysis、cost-effectiveness analysis、cost-utility analysis、cost-benefit analysis、cost-minimization、cost analysis、colorectal cancer、colorectal neoplasms、colorectal tumor与screening,early detection of cancer进行组合。纳入标准:(1)研究主体为结直肠癌筛查策略;(2)研究设计为完整的卫生经济学评价研究;(3)样本人群为一般风险人群。排除标准:(1)综述、文献评价等非原始研究;(2)重复发表、非英文和中文语种、会议摘要、无法获取全文等研究;(3)基于医院、高风险人群等机会性筛查的研究。结果本研究最终纳入80篇结直肠癌筛查卫生经济学评价研究。研究结果显示免疫法粪便潜血试验(FIT)、结肠镜(COL)以及乙状结肠镜(FS)在成本和健康改善结果上相对于其他筛查方法更有优势,其中FIT能以更低的成本带来更大的健康改善结果,因而最具有成本效益。其次已有研究结果显示缩短筛查间隔和扩大年龄覆盖面也均能在可接受的成本下带来更高的健康改善结果,具有更好的卫生经济学效果。结论从卫生经济学角度,建议在考虑资源可及性和人群依从性的情况下选择FIT作为筛查方法,缩短结直肠癌筛查间隔并适当扩大筛查年龄起止范围。同时,在进行针对我国适宜筛查策略的卫生经济学评价研究以及引用其他地区的研究时也需重视研究规范以及参数相关结论可推广性,从而为我国结直肠癌防控提供有效经济学证据。

Objective To systematically review the evidence and recent research progress on the economic evaluation of colorectal cancer screening and provide an economic evidence base for optimizing colorectal cancer screening.Methods Retrieve relevant articles from China National Knowledge Infrastructure(CNKI),Wanfang Knowledge Service Platform,VIP Chinese Science and Technology Journal Database,PubMed,Embase,Cochrane,and Web of Science databases from self built databases until April 1,2022.The Chinese database included health economics evaluation,health economics evaluation,cost-effectiveness analysis,cost-effectiveness analysis,cost-benefit analysis,minimum cost analysis,cost analysis,and colorectal cancer,Combination of colorectal tumors and screening as keywords.The English database was composed of economic evaluation,economic analysis,cost effectiveness analysis,cost utility analysis,cost benefit analysis,cost minimization,cost analysis,colored cancer,colored neoplasms,colored tubers,and screening,early detection of cancer.Inclusion criteria:(1)the object of evaluation was colorectal cancer screening strategy;(2)the study design was a complete health economics evaluation study;(3)the sample population was the general risk population.Exclusion criteria:(1)non-original studies such as reviews,literature evaluations,etc.;(2)studies with duplicate publications,non-English and Chinese languages,conference abstracts,unavailability of full text,etc.;(3)studies based on opportunistic screening such as hospitals and high-risk populations.Results This study ultimately includes 80 health economics evaluation studies on colorectal cancer screening.The research results showed that immunoassay fecal occult blood test(FIT),colonoscopy(COL),and sigmoidoscopy(FS)had advantages over other screening methods in terms of cost and health improvement results.Among them,FIT can bring greater health improvement results at lower cost,making it the most costeffective.Secondly,existing research has shown that shortening screening intervals and expanding age coverage could also bring higher health improvement results at an acceptable cost,with better health economics effects.Conclusions From the perspective of health economics,it is recommended to choose FIT as the screening method,taking into account resource accessibility and population compliance,to shorten the screening interval for colorectal cancer and appropriately expand the age range for screening.At the same time,when conducting health economics evaluation research on suitable screening strategies in China and citing research from other regions,it is also necessary to pay attention to research norms and the generalizability of parameter related conclusions,in order to provide effective economic evidence for the prevention and control of colorectal cancer in China.