目的基于Markov模型评价肺结节低剂量螺旋CT(LDCT)筛查的卫生经济学。方法利用2021年—2023年北京市某三甲医院的肺结节LDCT筛查数据和部分国外临床研究数据,采用成本效用分析方法,通过增量成本效用比(ICUR)确定优势筛查策略;使用R语言...目的基于Markov模型评价肺结节低剂量螺旋CT(LDCT)筛查的卫生经济学。方法利用2021年—2023年北京市某三甲医院的肺结节LDCT筛查数据和部分国外临床研究数据,采用成本效用分析方法,通过增量成本效用比(ICUR)确定优势筛查策略;使用R语言获得转移概率参数,利用TreeAge Pro 2011软件构建Markov模型。假设以我国10万名55岁及以上人群为肺结节筛查对象,模拟其疾病发展情况,并通过敏感性分析评价该模型的稳定性。结果成本效用分析显示,该模型经20次循环后,LDCT筛查策略的总成本为3543088618元,相较于不筛查策略的总成本增加了784130651元,额外获得了7996个质量调整生命年(QALY),每获得一个QALY需多花费98059.77元。采用WHO卫生经济学评价标准,LDCT筛查策略的ICUR大于1倍人均国内生产总值(GDP)但小于3倍人均GDP,为优势策略。敏感性分析显示,各变量在其敏感性分析范围内无论如何变化,都不会对ICUR产生较大影响,表明该模型具有较好的稳定性。结论在55岁及以上人群中开展每年一次肺结节LDCT筛查的ICUR小于3倍人均GDP,具有一定的经济学效用,该筛查策略有利于肺癌的“早发现、早诊断、早治疗”。展开更多
The way of neutral point to earth via full compensation arc suppression coil can solve the problem of residual current compensation in coal mine power network effectively. Based on the analysis on the grounding curren...The way of neutral point to earth via full compensation arc suppression coil can solve the problem of residual current compensation in coal mine power network effectively. Based on the analysis on the grounding current detection results of Xieqiao coal mine, the conclusion that harmonic component of grounding current is dominated by higher harmonics with complex harmonic sources in coal mine power network system was obtained. The influences of harmonic source type and fault point position on harmonic voltage and harmonic current were analyzed theoretically. The influences of earthed fault feeder detection result and the estimation errors of parameters to earth on residual current compensation were analyzed. A new thought of residual current prediction and the selections of model method and control method were proposed on this basis. The simulation results prove that harmonic amplitudes of zero sequence voltage and zero sequence current are determined by harmonic source type as well as fault point position in coal mine power network, and also prove that zero sequence voltage detection can avoid the unstable problem of coal mine power network system caused by undercompensation of capacitive current. Finally, the experimental device of full compensation arc suppression coil is introduced.展开更多
文摘目的基于Markov模型评价肺结节低剂量螺旋CT(LDCT)筛查的卫生经济学。方法利用2021年—2023年北京市某三甲医院的肺结节LDCT筛查数据和部分国外临床研究数据,采用成本效用分析方法,通过增量成本效用比(ICUR)确定优势筛查策略;使用R语言获得转移概率参数,利用TreeAge Pro 2011软件构建Markov模型。假设以我国10万名55岁及以上人群为肺结节筛查对象,模拟其疾病发展情况,并通过敏感性分析评价该模型的稳定性。结果成本效用分析显示,该模型经20次循环后,LDCT筛查策略的总成本为3543088618元,相较于不筛查策略的总成本增加了784130651元,额外获得了7996个质量调整生命年(QALY),每获得一个QALY需多花费98059.77元。采用WHO卫生经济学评价标准,LDCT筛查策略的ICUR大于1倍人均国内生产总值(GDP)但小于3倍人均GDP,为优势策略。敏感性分析显示,各变量在其敏感性分析范围内无论如何变化,都不会对ICUR产生较大影响,表明该模型具有较好的稳定性。结论在55岁及以上人群中开展每年一次肺结节LDCT筛查的ICUR小于3倍人均GDP,具有一定的经济学效用,该筛查策略有利于肺癌的“早发现、早诊断、早治疗”。
基金The financial support from the National Natural Science Foundation of China (No. 51107143)
文摘The way of neutral point to earth via full compensation arc suppression coil can solve the problem of residual current compensation in coal mine power network effectively. Based on the analysis on the grounding current detection results of Xieqiao coal mine, the conclusion that harmonic component of grounding current is dominated by higher harmonics with complex harmonic sources in coal mine power network system was obtained. The influences of harmonic source type and fault point position on harmonic voltage and harmonic current were analyzed theoretically. The influences of earthed fault feeder detection result and the estimation errors of parameters to earth on residual current compensation were analyzed. A new thought of residual current prediction and the selections of model method and control method were proposed on this basis. The simulation results prove that harmonic amplitudes of zero sequence voltage and zero sequence current are determined by harmonic source type as well as fault point position in coal mine power network, and also prove that zero sequence voltage detection can avoid the unstable problem of coal mine power network system caused by undercompensation of capacitive current. Finally, the experimental device of full compensation arc suppression coil is introduced.