疾病筛查的卫生经济学评价方法探讨

Exploring Health Economic Evaluation Methods for Disease Screening

目的:探讨疾病筛查的卫生经济学评价方法,为开展相关研究的学者提供参考。方法:通过整合现代流行病学、卫生统计学和卫生经济学中的相关内容,探讨分别采用真实性指标(灵敏度、特异度)和预测值指标(阳性预测值、阴性预测值)开展疾病筛查卫生经济学评价的差异,并结合文献中的案例进行实证研究。结果:真实性指标(灵敏度、特异度)属于诊断试验的固有指标,不受样本人群患病率的影响,更适合开展疾病筛查的卫生经济学评价,而且真实性指标易于获取,模型计算过程简洁、方便。案例研究结果显示,与风险评分法筛查2型糖尿病的增量成本效果比相比,空腹静脉血糖法为626,这表示风险评分法筛查组每多筛查出1例糖尿病患者需要多花626元。结论:建议采用真实性指标开展疾病筛查的卫生经济学评价,规范模型选择的路径方法,不断提高我国疾病筛查的卫生经济学评价方面的证据质量。

Objective:To explore the health economic evaluation methods of disease screening,providing insights for scholars conducting related research.Methods:By integrating relevant content from modern epidemiology,health statistics,and health economics,it investigates the differences in condueting health economic evaluations of disease screening using authenticeity indicators(sensitivity,speeficity)and predictive value indicators(positive predictive value,negative predictive value),and combines empirical studies with cases from the literature.Results:Authenticity indicators(sensitivity,specificity)are intrinsic measures of diagnostic tests,unaffected by the disease prevalence in the sample population,making them more suitable for conducting health economic evaluations of discase screening.Moreover,authenticity indicators are easy to obtain,and the model calculations are straightforward and convenient.Case study results demonstrate that compared to risk score sereening,the Incremental Cost-ffctiveness Ratio(ICER)of fasting plasma glucose(FPG)testing for type 2 diabetes is 626,indicating that for every additional diabetic patient identified through risk score screening,an extra 626 yuan is spent.Conclusion:It is recommended to use authenticity indicators for conducting health economic evaluations of disease screening,standardize the path methods for model selection,and continuously improve the evidence quality of health economic evaluations of disease screening in China.