文章摘要
王乐,石菊芳,黄慧瑶,朱娟,李江,方仪,代敏.我国乳腺癌筛查卫生经济学研究的系统评价[J].中华流行病学杂志,2016,37(12):1662-1669
我国乳腺癌筛查卫生经济学研究的系统评价
Economic evaluation on breast cancer screening in mainland China: a systematic review
收稿日期:2016-07-06  出版日期:2016-12-12
DOI:10.3760/cma.j.issn.0254-6450.2016.12.021
中文关键词: 乳腺肿瘤;筛查;经济学评估;系统综述
英文关键词: Breast neoplasms;Mass screening;Economic evaluation;Systematic review
基金项目:国家自然科学青年基金(81402740);教育部高等学校博士学科点专项科研基金(20131106120014);国家重大公共卫生服务项目-城市癌症早诊早治项目
作者单位E-mail
王乐 100021 北京, 国家癌症中心/中国医学科学院北京协和医学院肿瘤医院 城市癌症早诊早治项目办公室  
石菊芳 100021 北京, 国家癌症中心/中国医学科学院北京协和医学院肿瘤医院 城市癌症早诊早治项目办公室 shijf@cicams.ac.cn 
黄慧瑶 100021 北京, 国家癌症中心/中国医学科学院北京协和医学院肿瘤医院 城市癌症早诊早治项目办公室  
朱娟 100021 北京, 国家癌症中心/中国医学科学院北京协和医学院肿瘤医院 城市癌症早诊早治项目办公室  
李江 100021 北京, 国家癌症中心/中国医学科学院北京协和医学院肿瘤医院 城市癌症早诊早治项目办公室  
方仪 100021 北京, 国家癌症中心/中国医学科学院北京协和医学院肿瘤医院 乳腺外科  
代敏 100021 北京, 国家癌症中心/中国医学科学院北京协和医学院肿瘤医院 城市癌症早诊早治项目办公室  
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中文摘要:
      目的 了解我国大陆地区乳腺癌筛查的卫生经济学评价进展。方法 系统检索PubMed、中国知网、万方数据知识服务平台和维普网1995年1月至2015年12月收录文献,对纳入研究基本信息、人群项目参与率及检出率、模型研究方法学、经济学评价方法及结果等信息进行摘录和比较,采用卫生经济学评价报告规范(CHEERS)评价报告质量(总分24分)。结果 共检索356篇文献,最终纳入13篇,均发表于近4年(2012-2015年),其中11篇基于人群、3篇基于模型研究。筛查起始年龄为18~45岁,终止年龄均≥59岁;筛查技术包括临床检查、超声和钼靶单一或联合筛查。有7篇报道了研究角度,其中为政府等服务提供方5篇,社会角度2篇;仅有5篇研究进行了成本和(或)效果贴现。11篇成本-效果分析中,有9篇提供了评价指标检出1例乳腺癌的成本,为5.0~229.3(M=14.5)万元。以质量调整生命年(QALY)或伤残调整生命年(DALY)为指标的成本-效用分析仅4篇,相应增量成本效果比(ICER)为0.3万元~27.1万元(2015年我国人均GDP为4.9万元)。13篇文献平均得分14.5(9.5~21.0)分,总分24分,其中研究角度、贴现率、ICER及不确定性等维度得分较低。结论 我国大陆地区乳腺癌筛查的经济学研究尚处于起步阶段,尤其是模型研究;各研究间方法及结果可比性一般,报告质量有待加强。应从社会角度全面核算成本后对筛查项目开展以QALY或DALY为指标的成本-效用分析。
英文摘要:
      Objective To gather available evidence related to the economic evaluation on breast cancer screening in mainland China and to provide reference for further research. Methods A systematic review was conducted to identify articles in PubMed and three Chinese databases (CNKI, Wanfang and VIP) during 1995-2015. Data related to descriptive characteristics, rates on participation and detection for population-based studies, methods for model-based studies, types of economic evaluation and results, were extracted. A Consolidated Health Economic Evaluation Reporting Standards (CHEERS) was used to assess the reporting quality of included studies. Results Of the 356 records searched in the databases, 13 studies (all published between 2012 and 2015) were included in the current paper involving 11 population-based studies and 3 model-based evaluations (1 study using both methods). Age of the participants who started to be engaged in the screening program ranged from 18 to 45 years old, but terminated at the age of 59 years or older. The screening modalities included single-used clinical breast examination, mammography and ultrasound or combined applications. Study persepectives were described in 7 studies, with 5 from the healthcare providers, and 2 from societal angles. Only 5 studies discounted cost or effectiveness. Out of 11 papers, 9 showed the results on cost-effectiveness analysis (CEA) that reporting the cost per breast cancer detection, with median as 145.0 thousand Chinese Yuan (CNY), ranging from 49.7 thousand to 2 293.0 thousand CNY. From 4 papers with results of cost-utility analysis (CUA), the cost per quality adjusted life year (QALY) gained or cost per disability adjusted life year (DALY) averted, were evaluated. The incremental cost-effectiveness ratio (ICER) was from 2.9 thousand to 270.7 thousand CNY (GDP per capita of China was CNY 49.3 thousand in 2015). In 13 studies, the quality of reporting varied, with an average score of 14.5 (range:9.5-21.0). In the domains of study perspective, discounting, ICER and uncertainty, all the scores of equalities were relatively levels. Conclusions Currently, evidence on economic evaluation of breast cancer screening in mainland China remained limited and weakly comparable, particularly model-based studies. Comprehensive analysis from societal perspective and QALY or DALY related cost-utility analysis should be implemented.
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