| 汪雨婷,蔡 波,徐 红,等.2014—2023年江苏省南通市肝癌早诊早治项目的卫生经济学评价研究[J].中国肿瘤,2026,35(9):695-702. |
| 2014—2023年江苏省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 of Jiangsu Province， 2014—2023 |
| 投稿时间：2026-04-27 |
| DOI：10.11735/j.issn.1004-0242.2026.09.A006 |
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| 中文关键词: 肝癌 筛查 早诊早治 成本-效果分析 决策树模型 江苏 |
| 英文关键词:liver cancer screening early diagnosis and treatment cost-effectiveness analysis decision tree model Jiangsu |
| 基金项目:江苏省研究生科研与实践创新计划项目（KYCX25_3829） |
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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，利用2014—2023年南通市城癌项目数据，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37 212.72元/LYS，ICUR为36 750.69元/QALY，该值低于世界卫生组织早期建议的1倍南通市人均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（20 015.26元/QALY）低于女性；以45岁（ICUR：19 933.04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 (hereinafter referred to as the “cancer screening program”) in Nantong City， Jiangsu Province.［Methods］ Based on a societal perspective， this study constructed a decision tree model using data from the Nantong City cancer early diagnosis and treatment program from 2014 to 2023， to analyze the costs and health outcomes 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 evaluated using the incremental cost-effectiveness ratio (ICER) and the incremental cost-utility ratio (ICUR). ［Results］ From 2014 to 2023， the Nantong City cancer early diagnosis and treatment program conducted cancer risk assessments for 160 887 residents， of whom 18 845 were identified as high-risk， and 28 liver cancer cases were confirmed. Compared with no screening， the ICER of the screening group was 37 212.72 CNY/LYS and the ICUR was 36 750.69 CNY/QALY， both below the one time per capita GDP reference threshold of Nantong City as recommended earlier by the World Health Organization (WHO)， indicating that the screening strategy was cost-effective. Sensitivity analysis showed that parameters such as the high-risk detection rate and screening participation rate were sensitive to changes in the ICER and ICUR. Subgroup analysis showed that the ICUR in male (20 015.26 CNY/QALY) was lower than that in female， and liver cancer screening starting at age 45 (ICUR： 19 933.04 CNY/QALY) was more cost-effective. ［Conclusion］ Liver cancer screening is a cost-effective public health strategy. Priority should be given to screening high-risk males aged 45 and above， and to improving screening participation and adherence， so as to enhance screening effectiveness. |
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