摘要
目的总结大肠癌系统筛查方案的设计和应用,分析筛查成本。方法对一组大肠癌系统筛查资料进行回顾总结。用全人口进行问卷调查和粪隐血试验,检出大肠癌危险人群,进行结肠镜检查,以组织学诊断作为确诊大肠癌的金标准来评价筛查方案的价值。结果患大肠癌的危险人群约占全人口的5%。在大肠癌危险人群中,大肠肿瘤检出率约为23%,大肠癌的检出率为0.3%。如果选择乙状结肠镜检查,发现远端大肠肿瘤才进行全结肠镜检,将有72%的远端大肠肿瘤漏诊。计算从全人口和高危人群中每检出1例大肠癌的成本分别约20万元和5万元。首次筛查从高危人群中每检出1例大肠腺瘤的成本0.25万元。结论系统筛查可有效地从自然人口中检出大肠肿瘤,免疫法FOBT和全结肠镜检查可作为粪隐血试和肠镜检查的首选方法。每检出1例大肠癌的成本,系统性筛查是机会性筛查的4倍。
Objective To investigate the design and application of systematic screening program and estimate the cost-effectiveness of screening.Methods A retrospective study was performed with a set of systematic screening data of colorectal cancer（CRC）.A population-based questionnaire investigation and FOBT were used to screen high-risk populations,the colonoscopy was performed and CRC was confirmed by pathology.The value of the screening program was evaluated.Results Of general population,the proportion of high-risk populations was 5%.Of the high-risk populations,the detection rates of colorectal neoplasm and CRC were 23% and 0.3% respectively.If patients were suggested to performed colonoscopy only when they were diagnosed with colorectal neoplasm by sigmoidoscopy,70% lesions localized in the distal colon might be missed.The average direct costs for each detected colorectal cancer in general population and high-risk population were about 200,000 RMB yuan and 50,000 RMB yuan,respectively.By performing screening among high-risk populations,the direct cost for each detected adenoma was 2,500 RMB yuan.Conclusions Our study indicated that systematic screening among community setting was an effective method for detection of colorectal neoplasm.FIT and colonoscopy were the first choices for colorectal cancer screening.Our data showed that the average direct cost for each detected colorectal cancer by performing opportunistic screening was four times less than the cost of systematic screening.
出处
《临床医学工程》
2011年第5期797-799,共3页
Clinical Medicine & Engineering
基金
惠州市科学技术研究基金项目(NO:2010Y061)
关键词
大肠癌
系统筛查
成本分析
Colorectal cancer
Systematic screening
Cost-effectiveness analysi
