[1]安书仪,薛佳殷,李 苹,等.利用Markov模型进行胃癌高危人群胃镜监测的成本效果评价*[J].郑州大学学报(医学版),2017,(03):331-334.[doi:10.13705/j.issn.1671-6825.2017.03.022]
 AN Shuyi,XUE Jiayin,LI Ping,et al.A cost-effectiveness analysis evaluating endoscopic surveillance for high-risk population of gastric cancer using Markov model[J].JOURNAL OF ZHENGZHOU UNIVERSITY(MEDICAL SCIENCES),2017,(03):331-334.[doi:10.13705/j.issn.1671-6825.2017.03.022]
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利用Markov模型进行胃癌高危人群胃镜监测的成本效果评价*()
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《郑州大学学报(医学版)》[ISSN:1671-6825/CN:41-1340/R]

卷:
期数:
2017年03期
页码:
331-334
栏目:
应用研究
出版日期:
2017-05-15

文章信息/Info

Title:
A cost-effectiveness analysis evaluating endoscopic surveillance for high-risk population of gastric cancer using Markov model
作者:
安书仪薛佳殷李 苹黄水平#
徐州医科大学公共卫生学院流行病与卫生统计学教研室 江苏徐州 221004
Author(s):
AN ShuyiXUE JiayinLI PingHUANG Shuiping
Department of Epidemiology and Healthy Statistics,School of Public Health, Xuzhou Medical College, Xuzhou, Jiangsu 221004
关键词:
Markov模型 胃癌高危人群 胃镜 监测
Keywords:
Markov model high-risk population of gastric cancer gastroscopy surveillance
分类号:
R195.1
DOI:
10.13705/j.issn.1671-6825.2017.03.022
摘要:
目的:应用Markov模型对假设40岁胃癌高危人群(10 000人)进行不同胃镜监测随访策略间的成本效果分析,探索当前经济水平下对胃癌高危人群进行长期胃镜监测随访的最优策略。方法:考虑胃部不同疾病状态进展比例,模拟10 000例胃癌高危患者,评估2种随访策略:每年筛查一次的胃镜监测、每2 a筛查一次的胃镜监测。通过建立合适的Markov模型建立高危到胃癌发生的各种状态,以每1 a为周期计算出成本、效果,循环30 a后,计算出3种策略的增量成本效果比(ICER)进行比较,并通过敏感性分析评价参数对模型稳定性的影响。结果:每年筛查一次策略、每2 a筛查一次策略与不筛查策略相比分别减少了胃癌死亡人数381、193例。每年筛查一次策略与不筛查策略相比增加4 835.20个质量调整寿命年(QALY),其ICER为22 758.41元/QALY。每2 a筛查一次策略与不筛查策略相比增加 2 509.20个QALY,其ICER为21 974.07元/QALY。结论:在支付意愿为52 000元时,对40岁人群进行每年筛查一次或每2 a筛查一次监测策略均为有成本效果,最优策略为每年筛查一次。
Abstract:
Aim: To explore the optimal strategies for long-term monitoring of gastric cancer by evaluating the cost-effectiveness of gastroscopy surveillance in high-risk population of gastric cancer aged 40 years using Markov model at the present economic level.Methods: Using a reference strategy of no gastroscopy intervention, simulation of 10 000 high-risk patients with gastric cancer was set, and two strategies were evaluated: annual gastroscopy surveillance and 2-yearly gastroscopy surveillance. By collecting the state transition probabilities, Markov models were built to simulate the life experience of the target population. The models projected lifetime costs, quality adjusted life year(QALY), and incremental cost-effectiveness ratio(ICER)indicating the cost-effectiveness of each strategy. Sensitivity analysis was used to quantify the influence of parameter uncertainties.Results: Annual gastroscopy surveillance could respectively extend the lives of cohort 4 835.20 QALY than no gastroscopy surveillance, and the ICER was 22 758.41 Yuan/QALY, respectively. 2-yearly gastroscopy surveillance could extend 2 509.20 QALY than no gastroscopy surveillance,and the ICER was 21 974.07 Yuan/QALY.Conclusion: With the willingness-to-pay of 52 000 Yuan/QALY, the annual gastroscopy surveillance and 2-yearly gastroscopy surveillance both are cost-effective in the prevention of gastric cancer for high-risk population of gastric cancer aged 40 years. The annual gastroscopy surveillance is the optimal strategy.

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备注/Memo

备注/Memo:
*江苏省科技厅社会发展项目 BE2011647
#通信作者,女,1963年10月生,硕士,教授,研究方向:卫生统计方法在流行病研究中的应用,E-mail:hsp@xzmc.edu.cn
更新日期/Last Update: 2017-05-20