城市上消化道癌高危人群对内镜筛查的接受度与支付意愿

Acceptance and Willingness-to-pay for Endoscopic Screening of Upper Digestive Tract Cancer Among High-risk Populations in Urban China

[目的]调查我国城市上消化道癌高危人群对内镜筛查的接受度与支付意愿。[方法]基于2012～2014年城市癌症早诊早治项目的 13个省份,以高危风险模型筛查出的上消化道癌高危人群且接受进一步单一上消化道癌内镜筛查的居民为对象,面对面调查其对内镜筛查的接受度和在一定付费假设下的支付意愿,并进行分省份亚组分析。[结果]最终纳入分析对象共3256名。年龄(55.4±7.5)岁,男性占40.8%,近5年中位人均年收入为2.3万元。对于上消化道癌内镜筛查,90.0%的高危对象表示可以接受。假定将每3年1次的上消化道癌内镜筛查长期推行且需个人部分付费时,81.7%的高危对象表示愿意支付,但支付额度超过100元者仅占14.8%。其余18.3%无支付意愿者主要认为费用难以承受(38.2%)和检查痛苦(27.3%)。各省份间接受度和支付意愿存在统计学差异(P<0.05)。[结论]我国城市上消化道癌高危人群对内镜筛查的接受度和支付意愿较高,但支付额度较低,提示应提高居民对内镜筛查认知和自我健康的责任意识,改善筛查环境和技术操作以减轻被筛者不适。

[Purpose]To survey the acceptance and willingness-to-pay for endoscopic screening of upper Digestive tract cancer among high-risk populations in urban China.[Methods]From 2012 to 2014,a Cancer Screening Program in Urban China(CanSPUC)was initiated in 13 provinces,the current survey was conducted among those participants who were identified as high risk for upper gastrointestinal cancer by a risk-factor-evaluation-model(community-based)and then went through an endoscopic screening procedure(hospital-based).Data were obtained through a face-to-face questionnaire interview,mainly focusing on the acceptance and willingness-to-pay under certain self-payment assumption for endoscopic screening.[Results]The current analysis included a total of 3256 participants,with an average age of(55.4±7.5)years and median annual income per capita in recent 5 years of 23 thousand Chinese Yuan(CNY),40.8%of whom were males.Of all the participants,90.0%could totally or substantially accept the endoscopic screening.When the endoscopic screening was assumed to take every 3 years with a self-paid pattern,81.7%of participants had the willingness-to-pay,but only 14.8%of them would like to pay more than 100 CNY.The remaining 18.3%of participants showed no willingness-to-pay,and the main reasons were unaffordable expenditure(38.2%)and pain from endoscopic screening(27.3%).There was significant difference in acceptance and willingness-to-pay among provinces.[Conclusion]The acceptance for upper gastrointestinal cancer endoscopic screening among the selected high-risk populations is considerable.The willing-to-pay is relatively high but the amount of payment is limited and low,indicating the necessity of increasing individual’s awareness on endoscopic screening and self health responsibility,improving screening environment and procedure to alleviate the discomfort among screened participants.