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中国癌症防治杂志

中国癌症防治杂志 ›› 2025, Vol. 17 ›› Issue (3): 328-334.doi: 10.3969/j.issn.1674-5671.2025.03.10

• 其他消化系统肿瘤专栏 • 上一篇    下一篇

基于Markov模型的福建省上消化道癌筛查卫生经济学评价

  

  1. 福建医科大学肿瘤临床医学院，福建省肿瘤医院流行病研究室；电子科技大学医学院；泉州市疾病预防控制中心（泉州市卫生健康监督所）地方病与慢性非传染病防制科；惠安县疾病预防控制中心地方病防治与慢性病防治科/健康教育科；宁德市中医院脾胃科；连江县晓澳卫生院消化内科
  • 出版日期:2025-06-25 发布日期:2025-07-10
  • 通讯作者: 周衍 E-mail：zhouyan9893@163.com
  • 基金资助:
    福建省引导性科技计划项目（2022Y0055）

Health economic evaluation of upper gastrointestinal cancer screening in Fujian Province based on Markov model

  • Online:2025-06-25 Published:2025-07-10

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摘要： 目的 评估福建省上消化道癌不同筛查策略的卫生经济学效益，明确最佳筛查策略。方法 基于医疗保健系统的视角，利用调查数据和文献数据，开发了马尔可夫（Markov）模型。以不进行筛查为对照组，设计了4种不同的筛查策略（每2年、3年、5年和10年1次的筛查）。以生命年（life year,LY）、质量调整生命年（quality⁃adjusted life year,QALY）和净现值（net present value,NPV）分别作为成本效果、成本效用和成本效益的评价指标。计算每种筛查策略的增量成本效果比（incremental cost⁃effectiveness ratio, ICER）、增量成本效用比（incremental cost⁃utility ratio, ICUR）和NPV。以2023年福建省人均GDP（129 865元）作为支付意愿（willingness⁃to⁃pay,WTP）阈值，评估每种筛查策略的经济可行性。采用单因素敏感性分析和概率敏感性分析评估模型结果的稳健性。结果 与不进行筛查相比，每10年、5年、3年和2年进行筛查的ICER分别为每LY 4 215.47元、5 208.17元、5 566.44元和5 940.07元，ICUR分别为每QALY 4 316.71元、 5 397.35元、5 788.25元和6 183.54元，均显著低于WTP阈值。4种筛查策略的NPV均为正值，其中每2年1次的筛查被认为是最具成本效益的选择。敏感性分析显示，每2年1次的筛查在所有合理的参数变化中都保持了高度的成本效果，并且当每QALY的支付意愿超过20 000元时，达到了90%的成本效果概率，并趋于稳定。结论 福建省上消化道癌筛查具有良好的经济学效益，每2年1次的筛查是最佳策略。

关键词: 上消化道癌, 筛查策略, 卫生经济学评价, 马尔可夫模型

Abstract: Objective To evaluate the health economic benefits of various screening strategies for upper gastrointestinal cancer in Fujian Province and to determine the most effective approach. Methods A Markov model was developed from the perspective of the healthcare system, utilizing both survey and literature data. Four distinct screening strategies were proposed⁃screening every 2 years, 3 years, 5 years, and 10 years with no screening serving as the control. The life years (LY), quality⁃adjusted life years (QALY) and net present value (NPV) were served as the cost⁃effectiveness, cost⁃utility, cost⁃benefit evaluation indicators, respectively. The incremental cost⁃effectiveness ratio (ICER), incremental cost⁃utility ratio (ICUR), and NPV were calculated for each screening strategy. The economic viability of each strategy was assessed using the 2023 per capita GDP of Fujian Province (¥129,865) as the willingness⁃to⁃pay (WTP) threshold. One⁃way sensitivity analysis and probability sensitivity analysis were performed to assess the robustness of the results. Results Compared with no⁃screening strategy, the ICERs for screening strategies conducted every 10, 5, 3, and 2 years were ¥4,215.47/LY, ¥5,208.17/LY, ¥5,566.44/LY, and ¥5,940.07/LY, respectively. Similarly, the ICURs were ¥4,316.71/QALY, ¥5,397.35/QALY, ¥5,788.25/QALY, and ¥6,183.54/QALY, respectively, all of which were significantly below the WTP threshold.The NPVs of  four screening strategies were positive, with biennial screening emerging as the most cost⁃effective option. Sensitivity analysis showed that the biennial screening remained highly cost⁃effective across all reasonable parameter variations, achieving a cost⁃effectiveness probability of 90% and stabilizing when the WTP threshold exceeded ¥20,000 per QALY. Conclusions Upper gastrointestinal cancer screening in Fujian Province offers favorable economic benefits, with biennial screening identified as the optimal strategy.

Key words: Upper gastrointestinal cancer, Screening strategy, Health economic evaluation, Markov model

中图分类号: 

  • R735