摘要目的 评价不同鼻咽癌筛查方案的卫生经济学效果,确定经济学效果好的筛查方案.方法 构建基于鼻咽癌自然史的Markov模型,模拟采用7种不同筛查方案(方案A:每年1次；方案B:EB病毒血清学阳性者每年1次,EB病毒血清学阴性者3年1次；方案C:2年1次；方案D:3年1次；方案E:4年1次；方案F:5年1次；方案G:6年1次)对10万人进行鼻咽癌筛查,计算检出率、成本、质量调整寿命年(QALY)和增量成本效果比(ICER)等指标.结果 筛查方案A、B、C、D、E、F、G贴现后的QALY分别为23 079.9、22 955.6、22 810.4、22 636.5、22 522.7、22 445.0和22 361.9年,ICER分别为92 428.0、57 114.7、59 861.3、49 926.3、43 650.7、42 096.8和42 505.4元/QALY.筛查方案(B、C、D、E、F、G)的ICER均低于3倍的人均GDP(89 976元).方案A的检出率最高(81.7％),贴现后的QALY最多,鼻咽癌死亡人数最少(681例),但贴理后的成本较高且ICER大于89 976元.方案B的检出率(73.1％)、鼻咽癌死亡人数(707例)和QALY均仅次于方案A,而ICER下降了38.2％.结论 筛查方案B具有较优的卫生经济学效果,值得推荐.

abstractsObjective To evaluate the cost-effectiveness of different screening strategies for nasopharyngeal carcinoma (NPC) and recommend a preferable NPC screening strategy.Methods A Markov simulation model was constructed based on the natural history of NPC.Seven strategies ( A.Annual screening； B. Annual screening for (Epstein-Barr virus,EBV) EBV-seropositive subjects,triennial screening for seronegative subjects； C.Biennial screening； D.Triennial screening； E.4-year screening； F.5-year screening； G.6-year screening) were evaluated.The NPC-pickup rate,cost,quality-adjusted lifeyears (QALYs) and incremental cost-effectiveness ratio (ICER) were calculated.Results The ICERs of the 7 strategies were 83 111.6,47 768.9,50 164.7,40 016.2,34 272.8,32 215.6,and 32 248.0 Yuan/QALY,respectively.The discounted QALYs of the strategies were 23 079.9,22 955.6,22 810.4,22 636.5,22 522.7,22 445.0,and 22 361.9 years,respectively.The ICERs of the strategies were less than three times of the average per capita gross domestic product (89 976 Yuan) in China in 2010.The strategy A achieved a highest NPC pick-up rate (81.7％),a highest discounted QALY and a smallest number of NPC death (681),but a highest discounted cost and a greatest ICER.Compared with the strategy A,the strategy B achieved a little smaller NPC pick-up rate (73.1％),a little smaller number of NPC death (707),however,the ICER of the strategy B decreased by 38.2％.Conclusion The strategy B ( annual screening for EB virus seropositive subjects and triennial screening for seronegative subjects) is a preferable option for NPC screening.