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近年来,前列腺癌已日益成为许多国家的卫生问题。然而,如果在早期阶段就确诊的话。前列腺癌是可以治疗的。因此,采取有效的筛检方法可以改变其病程,并减少总死亡率。但目前对这类筛检的效益仍存在争议。我们进行了一项采用直肠指检法为筛检的试验,目的是研究其在组织体制、社会和经济方面的问题,所获资料用以估价在瑞典卫生服务中前列腺癌筛检的后果。评价方法采用决策分析模型。研究结果表明,用直肠指检法来筛检前列腺癌,不仅可以成为初级卫生保健的一个重要环节,而且受到公众的高度欢迎,但卫生部门要为此作出高昂的普查费用。在瑞典,未来的两年中,即使不搞筛检,预计也要为确诊的前列腺癌患者支出5,300万美元医疗费,将有1,048病人接受某种可能的治疗。如采用直肠指检法来筛检的话,未来2年中的医疗费将达13,100万美元,同对有6,522名病人将获得及时治疗。如再加上输尿管超声波检查,费用将达17,400万美元,接受治疗的病人将增加到10,275名。这种增加及时治疗病人数量最终的卫生效益目前仍不能确定。我们认为这种作法确有成本效益的科学依据,采用不同筛检方案来分析其经济后果的模型,将证明对于制定解决这一复杂问题的政策是极为有用的。
In recent years, prostate cancer has increasingly become a health problem in many countries. However, if diagnosed at an early stage. Prostate cancer is treatable. Therefore, taking an effective screening method can change the course of the disease and reduce the total mortality. However, there is still controversy over the effectiveness of such screening. We conducted a trial using rectal examination as a screening test to study its institutional, social, and economic problems. The data obtained were used to evaluate the consequences of prostate cancer screening in Swedish health services. The evaluation method adopts a decision analysis model. The results of the study indicate that screening for prostate cancer with digital rectal examination can not only be an important part of primary health care, but also highly welcomed by the public. However, the health department must make high screening costs for this purpose. In Sweden, in the next two years, even without screening, it is expected to spend $53 million on medical expenses for diagnosed prostate cancer patients. There will be 1,048 patients receiving some possible treatment. If rectal examination is used for screening, medical expenses in the next two years will reach US$131 million, and 6,522 patients will receive timely treatment. With the addition of ureteral ultrasound, the cost will reach US$174 million and the number of patients undergoing treatment will increase to 10,275. The ultimate health benefits of this increase in the timely treatment of patients are still uncertain. We believe that this approach does have a cost-effective scientific basis and that adopting different screening schemes to analyze its economic consequences model will prove to be extremely useful for formulating policies to solve this complex problem.