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| 2014-2023年南通市肝癌早诊早治项目的卫生经济学评价研究 |
| Health Economic Evaluation of Liver Cancer Early Diagnosis and Treatment Program in Nantong City, 2014-2023 |
| 投稿时间：2026-04-27 修订日期：2026-07-30 |
| DOI： |
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| 中文关键词: 肝癌 筛查 成本-效果分析 决策树模型 南通 |
| 英文关键词:liver cancer screening cost-effectiveness analysis decision tree model Nantong |
| 基金项目:江苏省研究生科研与实践创新计划项目 |
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| 中文摘要: |
| 摘要
目的：评价江苏省南通市城市癌症早诊早治项目（以下简称“城癌项目”）中肝癌筛查的成本效果。
方法：本研究基于全社会视角构建决策树模型，分析肝癌筛查与不筛查两种策略下的成本与健康产出。成本涵盖筛查成本、直接医疗成本、直接非医疗成本及间接成本；健康产出以挽救的生命年（life years saved, LYS）和质量调整生命年（quality-adjusted life year, QALY）进行衡量。通过增量成本-效果比（incremental cost-effectiveness ratio, ICER）与增量成本-效用比（incremental cost-utility ratio, ICUR）评估筛查策略的成本效果。
结果：2014-2023年南通市城癌项目累计对160 887名居民开展癌症风险评估，其中18 845人为高危人群，共确诊28例肝癌患者。与不筛查相比，筛查组的ICER为27 619.17元/LYS，ICUR为27 337.86元/QALY，该值低于世界卫生组织早期建议的1倍南通人均GDP参考阈值，表明筛查策略具有成本效果。敏感性分析显示，高危人群检出率、筛查参与率等参数对ICER与ICUR变动敏感；亚组分析显示，筛查组中男性的ICUR（15 241.08元/QALY）低于女性；以45岁（ICUR：13 948.40元/QALY）为起点的肝癌筛查更加具有成本效果。
结论：开展肝癌筛查是具有成本效果的公共卫生策略，应重点关注45岁及以上男性高危人群筛查和筛查参与依从性，提升筛查效果。 |
| 英文摘要: |
| Abstract
Purpose: To evaluate the cost-effectiveness of liver cancer screening within the urban cancer early diagnosis and treatment program in Nantong city.
Methods: Based on a societal perspective, this study constructed a decision tree model to analyze the health outcomes and economic burden of liver cancer screening versus no screening. Costs included screening costs, direct medical costs, direct non-medical costs, and indirect costs. Health outcomes were measured in terms of life years saved (LYS) and quality-adjusted life years (QALY). The cost-effectiveness of the screening strategy was assessed by calculating the incremental cost-effectiveness ratio (ICER) and the incremental cost-utility ratio (ICUR).
Results: The Nantong city cancer screening program conducted risk assessments for 160887 residents, identifying 18845 individuals as high-risk, with 28 cases confirmed from 2014 to 2023. Compared with no screening, the screening strategy yielded an ICER of 27 619.17 CNY/LYS and an ICUR of 27 337.86 CNY/QALY, both below the one-time per capita GDP threshold of Nantong city, indicating that the screening strategy was cost-effective. Sensitivity analysis showed that the high-risk detection rate and screening participation rate were sensitive parameters affecting ICER and ICUR. Subgroup analysis showed that the ICUR (15 241.08 CNY/QALY) in the screening group was lower in males than in females, and liver cancer screening starting at the age of 45 (ICUR: 13 948.40 CNY/QALY) was more cost-effective.
Conclusion: Liver cancer screening is a cost-effective public health strategy. Priority should be given to high-risk males aged 45 and above, and efforts should focus on improving screening participation and compliance to enhance screening effectiveness. |
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