摘要
目的对糖尿病患者开展肺结核筛查的效果与成本效益分析,为政府相关决策提供参考。方法通过上海市徐汇区慢性病综合管理平台中糖尿病管理信息系统搜集2014年6月、2015年6月在上海市徐汇区疾病预防控制中心(简称“CDC”)登记并进行社区管理的15岁及以上糖尿病患者,最终确定免费筛查患者分别为2014年32800例和2015年33723例。于筛查开始前1个月内(筛查时间为每年8、9月份)通过电话和上门告知其在约定时间至社区卫生服务中心,现场采用数字X线摄影术(digitalradiography,DR)筛查肺结核。采用SPSS17.0软件对两年筛查情况开展筛查成本[本次筛查将筛查成本考虑为社会总成本,包括卫生部门投入的经费(显性成本)和糖尿病患者提供胸片产生的费用(隐性成本)]、社会效果、社会效益、成本-效用比、效益-成本比数据进行统计学分析,计数资料的比较采用Fisher确切概率法,以P<0.05为差异有统计学意义。结果最终38617例次(2014、2015年分别为19723、18894例次)糖尿病患者进行了DR筛查[现场进行DR筛查21030例次(54.46%)、提供胸片检查报告17587例次(45.54%)],其中9944例糖尿病患者参与了2年的筛查,故2年合计开展了DR筛查28673例。2014、2015年筛查发现9例患者,均为50岁以上患者;发现率分别为25.35/10万(5/19723)和21.17/10万(4/18894),且男性患者的检出率(64.98/10万,8/12311)明显高于女性(6.11/10万,1/16362)(Fisher确切概率法,P=0.006)。通过成本效益分析,本次筛查社会成本总支出经费为308.94万元(人民币,下同)(80×38617),实际卫生部门显性成本投入为185.83万元。可减少结核病死亡患者2.25例,可使67.50~101.25名健康人避免感染,可减少社会医疗费用38.18万~57.28万元,可避免85.5个DALY损失,可挽回间接社会总价值575.66万元。社会成本-效用比为3.61万元(308.94/85.5),显性成本-效用比为2.17万元(185.83/85.5)。社会效益-成本比为2.02[(47.73+575.66)/308.94],显性效益-成本比为3.35[(47.73+575.66)/185.83]。结论徐汇区糖尿病患者通过胸片方式开展肺结核筛查的效益-成本比不高,不适合开展大范围的肺结核筛查;可重视男性、高龄糖尿病患者的肺结核筛查。
Objective In order to provide reference for the relevant policy making by government, a cost-effectiveness analysis of tuberculosis (TB) screening in patients with diabetes was conducted. Methods The related data and information were collected from the patients with diabetes aged 15 years old or above and were registered by Xuhui District CDC of Shanghai in June 2014 or June 2015 respectively through the diabetes management information system which was based on a comprehensive management platform of chronic disease in Xuhui District, Shanghai. Finally, 32800 patients who were registered in 2014 and 33723 patients who were registered in 2015 were enrolled into this analysis and received TB screening free of charge. The screening date was arranged in August and September each year. One month before the screening date, the enrolled patients were informed by phone call or visiting to come to the community health service centers at the appointed time for TB screening on the spot using digital radiography (DR). SPSS 17.0 software was used for statistical analysis to the following data: TB screening cost which was considered as the total social costs, including the investment of the health sector (explicit cost) and the cost of chest X-ray film which provided by the diabetes patients (implicit cost), Social effect, Social benefit, Cost-effectiveness ratio, Benefit-cost ratio. Fisher’s exact probability method was used to compare the counting data with P<0.05 as the statistical significance. Results A total of 38617 diabetes patients (19723 cases in 2014 and 18894 cases 2015) received TB screening with DR (21030 cases received DR screening on the spot while 17587 cases provided the chest X-ray examination reports). Out of 38617 patients, 9944 patients participated in the screening in both years, so in actually 28673 patients received TB screening in two years. A total of 9 pulmonary TB patients were found during the screening in 2014 and 2015. Those detected patients aged above 50 years;the detection rate was 25.35/100000 (5/19723) and 21.17/100000 (4/18894) respectively in 2014 and 2015;the detection rate of pulmonary TB in the male diabetes patients (64.98/100000, 8/12311) was significantly higher than that in the female diabetes patients (6.11/100000, 1/16362)(Fisher’s exact probability method, P=0.006). The results of cost-effectiveness analysis showed that the total expenditure of social cost in the screening was RMB 3089400 yuan and the explicit cost investment by the health sector was RMB 1858300 yuan. The TB screening could reduce the TB death by 2.25 cases, avoid TB infection by 67.50-101.25 healthy people, reduce social medical expenses by RMB 381800-572800 yuan, avoid 85.5 DALY losses and recover the indirect social value by RMB 5756600 yuan. The social cost-effectiveness ratio was RMB 36100 yuan (3089400/85.5), and the dominant cost-effectiveness ratio was RMB 21700 yuan (1858300/85.5). The social benefit-cost ratio was 2.02 ((477300+5756600)/3089400) and the dominant benefit-cost ratio was 3.35 ((477300+5756600)/1858300). Conclusion The benefit-cost ratio of TB screening with chest X-ray in diabetic patients in Xuhui District is not high, so it is not suitable for large-scale TB screening;attention should be paid to TB screening in male and elderly patients with diabetes mellitus.
作者
汪娟
许缃
蔡晓峰
杨美霞
WANG Juan;XU Xiang;CAI Xiao-feng;YANG Mei-xia(Department of AIDS,STD,Tuberculosis and Leprosy Prevention and Control,Xuhui District Center for Disease Control and Prevention,Shanghai 200237,China)
出处
《中国防痨杂志》
CAS
CSCD
2019年第9期968-973,共6页
Chinese Journal of Antituberculosis
关键词
糖尿病
结核
肺
多相筛查
成本及成本分析
费用效益分析
Diabetes mellitus
Tuberculosis
pulmonary
Multiphasic screening
Costs and cost analysis
Cost-effectiveness analysis
