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目的针对无锡地区以人乳头瘤病毒(human papillomavirus,HPV)DNA分型检测为基础的宫颈癌筛查进行卫生经济学评价。方法运用Markov模型对2013年无锡市185 328名妇女以HPV基因分型检测为基础的宫颈癌筛查数据进行预测,预测之后10年的情况,以自然发展组为对照,计算终身筛查一次、每3年筛查一次、每5年筛查一次的队列分布,结合筛查费用及治疗费用分析评价成本效果、成本效益和成本效用等卫生经济学指标。结果终身筛查一次、每3年筛查一次和每5年筛查一次与自然发展相比,10年可以累计增加的质量调整生命年(quality adjusted life year,QALY),分别是481.75、2 865.35、1 949.84;CIN2以上患病率分别降低了4.90%、42.26%、28.06%;死亡率分别降低了1.13%、2.03%、1.59%;每挽救一个生命年的成本分别是30 991.30元、70 612.81元、55 654.18元;每挽救1个质量调整生命年的成本分别是19 234.9元、11 311.5元、10 817.8元;每投入1个单位成本所获得的效益分别是3.04、5.27、5.55。结论每5年筛查一次的方案比较适合无锡这种中小城市的宫颈癌防控。
Objective To evaluate the health economics of cervical cancer screening based on the detection of human papillomavirus (HPV) DNA typing in Wuxi area. Methods The Markov model was used to predict the cervical cancer screening based on HPV genotyping in 185 328 women in Wuxi in 2013. After 10 years of predicting the situation of cervical cancer screening in natural development group, Screening every 3 years and screening every 5 years co-ordinate the screening of costs and treatment costs analysis of cost-effectiveness, cost-effectiveness and cost-effectiveness of health economics indicators. Results Lifelong Screening, Screening every 3 Years and Screening every 5 Years Quality adjusted life year (QALY), cumulatively 10 years increased compared to natural development, were 481.75 and 2 865.35, respectively , And 1 949.84 respectively; the prevalences of CIN2 and above were reduced by 4.90%, 42.26% and 28.06% respectively; the mortality rates were reduced by 1.13%, 2.03% and 1.59% respectively; the cost of saving one life year was 30,991.30 yuan and 70 612.81 respectively Yuan, 55 654.18 yuan; the cost of saving one quality-adjusted life year each is 19 234.9 yuan, 11 311.5 yuan and 10 817.8 yuan respectively; the benefits obtained for each unit cost of investment are 3.04, 5.27 and 5.55 respectively. Conclusion The screening plan every 5 years is more suitable for the prevention and control of cervical cancer in small and medium-sized cities such as Wuxi.