乳腺超声和钼靶X线对中国女性乳腺癌筛查的卫生经济学评价

摘要

Objective: This study aims to analyze the cost-effectiveness and cost-utility of ultrasonography screening, mammography screening and no screening for breast cancer among Chinese women.Methods: A Markov model was developed from a societal perspective among asymptomatic Chinese women over 40 years who are at risk for breast cancer over a lifetime horizon.The decision model was populated with data derived from China, discounted at 3%.After getting the incremental cost-utility ratio (ICUR), this paper explores the parameter uncertainty using one-way sensitivity analysis and probabilistic sensitivity analysis.Subgrouping analysis was conducted based on different city levels and geographical areas in China.Results: Compared to no screening, the incremental cost-utility ratio of ultrasonography screening is ￥102653/QALY and the ICUR of mammography screening is ￥201309/QALY.In probabilistic sensitivity analyses, the probabilities of the ICUR being a threshold of ￥140000/QALY are 54.5% for annual ultrasonography and 26.2% for annual mammography.The subgrouping analysis shows that compared with no screening the ultrasonography screening for breast cancer has high cost-utility in all levels of cities and all geographic areas in China.The ICUR of mammography screening compared with no screening is very close to the threshold in eastern China.Conclusions: Ultrasonography screening could be used as the primary method for breast cancer screening in China, while mammography screening could only be used in economically developed areas in eastern China.%目的:评价中国女性使用乳腺超声、钼靶X线和不筛查三种乳腺癌筛查方式的成本效果和成本效用. 方法:采用中国数据,建立Markov决策模型,对每年进行一次乳腺超声筛查、每年进行一次钼靶X线筛查和不筛查的40岁以上女性进行终生队列模拟,以3%贴现率进行贴现.以不筛查组的成本和效用作为基线得到增量成本效用比,并使用单因素敏感度分析和概率敏感度分析验证模型的稳健性,同时对中东西部地区和不同类型城市进行亚组分层分析. 结果:与不筛查相比,乳腺超声筛查和钼靶X线筛查的增量成本效用比分别为102 653元/QALY和201 309元/QALY.概率敏感度分析结果显示,乳腺超声和钼靶X线具有成本效用的概率分别为54.5%和26.2%.乳腺超声筛查在不同地区和不同类型城市的亚组分析结果无差异,钼靶X线筛查在东部地区的增量成本效用比与意愿支付阈值接近. 结论:乳腺超声筛查可考虑作为我国乳腺癌筛查项目的主要方法,但钼靶X线筛查只适合在东部经济较发达地区使用.