筛查幽门螺杆菌预防胃癌的Markov模型卫生经济学评价

王倩; 林果为; 金丕焕; 陈洁; 徐三荣

Abstract

王倩,林果为,金丕焕,陈洁,徐三荣.筛查幽门螺杆菌预防胃癌的Markov模型卫生经济学评价[J].Chinese journal of Epidemiology,2003,24(2):135-139

筛查幽门螺杆菌预防胃癌的Markov模型卫生经济学评价

Cost-effectiveness of Helicobacter pylori screening to prevent gastric cancer: Markov decision analysis

Received:April 28, 2002

DOI：

KeyWord: 螺杆菌,幽门胃肿瘤费用效益分析模型分析筛查

English Key Word: Helicobacter pylori Stomach neoplasm Cost effectiveness analysis Decision model Screen

FundProject:

Author Name	Affiliation
WANG Qian	Center of Clinical Epidemiology, Huashan Hospital of Fu Dan University, Shanghai 200040, China
JIN Pi huan	Center of Clinical Epidemiology, Huashan Hospital of Fu Dan University, Shanghai 200040, China
LIN Guo wei	复旦大学公共卫生学院卫生统计教研室
CHEN Jie	医院管理教研室
XU San rong	复旦大学附属华山医院消化内科

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Abstract:

目的评价人群中筛查幽门螺杆菌(Hp)感染预防胃癌的干预措施。方法用Markov模型MonteCarlo分析法估计筛查的远期效果和费用,并进行增量分析。结果当根治Hp感染能减少胃癌发生的有效率为50%时,在30～40岁的人群中进行一次性筛查Hp感染并治疗阳性者可减少16.6%的胃癌发生,每减少一例胃癌的费用为10405元(95%Cl:4238～27727元),每增加一个质量调整生命年所增加的费用为64元(95%Cl:31～97元),每延长一个生命年所增加的费用为1374元(95%Cl:352～86624元)。结论筛查Hp感染能减少部分胃癌的发生,在胃癌高发区筛查的效果更好,增量费用效果比较低

English Abstract:

Objective Using Markov model Monte Carlo simulation to conduct a cost effectiveness analysis of screening Helicobacter pylori (H.pylori) infection to prevent gastric cancer.Methods The Markov model was developed based on the natural course from H.pylori infection to gastric cancer. Two strategies were compared:①screening for H.pylori and treatment for those with positive tests, and ②without screening and treatment. Data used for model simulation including transition probability, efficacy of test and treatment were collected from related research publications. Markov model Monte Carlo simulation combined with bootstrap method was used to perform base case analysis and estimate the confidence interval of cost effectiveness ratios. The probability sensitivity analysis was used to estimate the cost effectiveness in multiple uncertainty factors. Results Assuming H.pylori eradication will prevent 50% of attribute gastric cancer, the screening strategies would prevent 16.6 % cases of gastric cancer. Cost effectiveness were 10 405 Yuan (95% CI : 4 238 27 727 Yuan) per GC prevented, 64 Yuan (95% CI : 31 97 Yuan) per QALY saved and 1 374 Yuan (95% CI :352 86 624 Yuan) per life year saved.Conclusion Screening and treatment for H.pylori infection in population was potentially effective in the prevention of gastric cancer,and screening in high incidence area of gastric cancer would be more effective and economic.

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