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目的 进行心血管病社区人群干预的成本效果分析。方法 以北京房山区心血管病综合防治研究为依托 ,计算 1992～ 1997年的干预成本和干预区节省的心血管病费用 ,以失能调整生命年作为效果指标进行成本效果分析。结果 1992～ 1997年 ,每挽回一个生命年所需人民币分别为15 86 0 0、1380 2 0、- 2 35 0 80、- 90 5 30、- 1495 6 0和 - 176 6 70元 ,随干预时间的延长 ,干预区每挽回一个生命年所需要的成本越来越少 ,干预 2年后 ,成本效果比变为负值 ,即干预措施出现正效益。1992～ 1997年 ,总的效益比约为 4∶1,即每投入 1元人民币 ,节省心血管病费用 4元人民币。灵敏度分析显示 ,成本效果比对贴现率、年龄权重参数和脑卒中、冠心病住院费用年增长率的敏感性较小 ,成本效果分析的结论可靠。结论 对农村社区人群进行心血管病综合干预可明显节省心血管病费用并且有较好的效益比。
Objective To analyze the cost effect of community intervention in cardiovascular disease. Methods Based on the comprehensive prevention study of cardiovascular disease in Fangshan District of Beijing, the cost of intervention and the cost of cardiovascular disease saved in the intervention area were calculated from 1992 to 1997. The cost-effectiveness analysis was performed using disability-adjusted life years as an effect index. Results From 1992 to 1997, RMB 1 586 0, 1380 2 0, - 2 35 0 80, - 90 5 30, - 1495 6 0, and - 176 6 70 yuan were required for every one-year life saved. With the extension, the cost required to save one life year in the intervention area is getting less and less, and after 2 years of intervention, the cost-effectiveness ratio becomes negative, that is, the intervention measures have positive benefits. From 1992 to 1997, the total benefit ratio was about 4:1, which means that for every RMB 1 invested, the cost of cardiovascular disease was saved by RMB 4 yuan. Sensitivity analysis showed that the cost-effectiveness ratio was less sensitive to the discount rate, age weight parameters, and the annual growth rate of hospital costs for stroke and coronary heart disease, and the cost-effectiveness analysis was reliable. Conclusion Comprehensive interventions for cardiovascular disease in rural community population can significantly reduce the cost of cardiovascular disease and have a better benefit ratio.