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[目的]评估2002~2005年上海市社区肝癌高危人群筛检的效果,从卫生经济学方面探讨经济有效的筛检方法。[方法]对上海市健康档案和医院门诊对象中符合肝癌高危人群标准并愿意参加的3 280例对象进行“AFP+B超”筛检。运用项目成本测算方法计算筛检的成本,以发生肝癌例数和早中期肝癌例数作为效果指标进行成本效果分析。[结果]社区肝癌高危人群筛检的总成本为4 025 544.00元。高危人群的随访筛检次均成本为411.80元。去除间接成本部分,次均直接成本为21.80元,次均自付直接成本为15.00元。发现1例肝癌和早中期(Ⅰ期和Ⅱ期)肝癌患者的总成本分别为575 077.71元和1 006 386.00元。[结论]以10万人社区为假设,每人每年增加0.24元专项肿瘤筛查经费就能有效地发现早中期肝癌患者。
[Objective] To evaluate the screening effect of high-risk population of liver cancer from 2002 to 2005 in Shanghai, and to explore a cost-effective screening method from the aspect of hygiene economics. [Method] The “AFP + B-ultrasonography” screening was performed on 3 280 subjects in Shanghai health records and hospital outpatients who met the high risk of HCC group and were willing to participate. The project cost calculation method was used to calculate the cost of screening, and the cost-effectiveness analysis was made on the number of cases of liver cancer and the number of cases of early and mid-stage liver cancer as effect indicators. [Results] The total cost of community screening for high-risk groups of liver cancer was 4 025 544.00 yuan. The average cost of follow-up screening of high-risk groups was 411.80 yuan. Remove the indirect costs, the average direct cost was 21.80 yuan, the average cost is 15.00 yuan pays the direct costs. Found that the total cost of one case of liver cancer and early and mid-stage (stage I and II) patients with liver cancer were 575,077.71 yuan and 1,006,386.00 yuan respectively. [Conclusion] Based on the community of 100,000 inhabitants, an extra 0.24 yuan per year for special cancer screening can effectively find patients with early-stage liver cancer.