摘要目的：比较和评价应用不同内镜技术进行早期胃癌筛查的成本效果。方法研究对象为中国大陆地区40岁以上门诊机会性胃镜筛查人群，经普通白光内镜发现局灶性黏膜病变患者。选取全社会角度，通过建立决策树模型对以下5种不同内镜筛查技术的成本效果进行比较：（1）普通白光内镜（WLE）；（2）放大胃镜结合窄带成像（ME?NBI）；（3）色素放大内镜?肾上腺素染色（ME?EPI）；（4）色素放大内镜?靛胭脂染色（ME?IDC）；（5）色素放大内镜?冰醋酸加靛胭脂染色（ME?AIM）。临床收益为筛查发现早期胃癌及癌前病变患者的数量。模型运算所用的基准分析数据主要来源于国内多中心、大规模针对门诊机会性胃镜筛查人群进行的相关研究结果。敏感度分析应用单因素敏感度分析。结果模型评估数据显示对于门诊机会性胃镜筛查人群经WLE发现局灶性黏膜病变后，应用ME?NBI、ME?EPI、ME?IDC及ME?AIM 4种不同增强放大内镜技术的临床收益基本相当，而 ME?AIM花费低于其他方法，同其他3种增强放大内镜技术及WLE比较，具有最佳成本效果。敏感度分析结果显示存在局灶病变的筛查人群的早期胃癌及癌前病变患病率、ME?AIM方法的敏感度以及色素放大胃镜的成本是影响最终成本效果分析结果的3个最主要因素。结论在中国应用ME?AIM对门诊机会性筛查人群进行早期胃癌筛查可能具有更优的成本效果。

abstractsObjective To assess and compare the cost?effectiveness of different enhanced magnifying endoscopic technologies for early gastric cancer screening in Chinese patients with focal gastric le?sions. Methods Target population was Chinese patients over forty years old with focal gastric lesions. A de?cision?tree model was constructed to compare the costs and clinical effectiveness of different endoscopic tech?nologies for early gastric cancer screening. The endoscopic technologies included conventional white light en?doscopy ( WLE ) , magnifying endoscopy enhanced with narrow?band imaging ( ME?NBI ) , magnifying endoscopy enhanced by epinephrine(ME?EPI), magnifying endoscopy enhanced by indigo carmine(ME?IDC) and magnifying endoscopy enhanced by acetic acid?indigo carmine mixture( ME?AIM) . The main out?comes were the number of detected early gastric cancer and precancerous lesions. Data for base analysis mainly came from research results of domestic multicenter, large?scale opportunistic screening for early gastric cancer. Sensitivity analysis was conducted by using one?way sensitivity analysis. Results The esti?mated clinical benefit was similar for the four different enhanced magnifying endoscopic technologies. Howev?er, the screening cost was lower when using ME?AIM. ME?AIM had the best cost?effectiveness compared with three other technologies. The results showed morbidity of early gastric cancer in Chinese patients with early gastric cancer and precancerous lesions, the sensitivity and the cost of ME?AIM were the 3 main factors that influenced cost?effectiveness. Conclusion ME?AIM may be the most cost?effective for early gastric cancer screening in Chinese patients with focal gastric lesions.