CAJ | 학술논문

目的：对北京市大肠癌筛查项目进行成本分析。方法采用分层整群抽样，于2012年10月至2013年5月在北京东城、西城、朝阳、海淀、丰台、石景山6个城区的19所社区卫生服务机构以问卷形式开展“癌症风险评估”初筛，筛查对象为40～69岁的在本地居住3年以上的常住人口，排除严重的器官功能障碍者，共有12953名。通过问卷调查筛查出大肠癌高危人群2487例，预约肠镜检查人数为1055名，实际接受临床检查人数375名，肠镜筛查参与率为35.5%。以筛查结果和对筛查受访者的间接费用数据为基础，以描述性统计分析为主要手段，对本次北京市大肠癌筛查的成本进行归纳测算，在此基础上测算出本次大肠癌筛查工作单例癌症患者的检出成本，并对本次筛查人群全病程治疗费用与非筛查人群进行比较分析。结果在12953名调查对象中，共观察到大肠癌癌前病变71例，癌前病变检出率546.2/10万；癌症9例，检出率69.2/10万。北京大肠癌筛查项目的直接投入费用为227136.80元，筛查对象交通投入0.42万元，筛查出1例大肠癌患者的检出成本推算约为1.99万元。本次筛查人群大肠癌全病程治疗费用分别为84.28万元，非筛查人群为120.28万元，筛查人群大肠癌疾病诊疗费用比非筛查人群低12.87万元。结论以肠镜为主要筛查手段的大肠癌筛查工作可以减轻社会的医疗卫生经济负担。
목적：대북경시대장암사사항목진행성본분석。방법채용분층정군추양，우2012년10월지2013년5월재북경동성、서성、조양、해정、봉태、석경산6개성구적19소사구위생복무궤구이문권형식개전“암증풍험평고”초사，사사대상위40～69세적재본지거주3년이상적상주인구，배제엄중적기관공능장애자，공유12953명。통과문권조사사사출대장암고위인군2487례，예약장경검사인수위1055명，실제접수림상검사인수375명，장경사사삼여솔위35.5%。이사사결과화대사사수방자적간접비용수거위기출，이묘술성통계분석위주요수단，대본차북경시대장암사사적성본진행귀납측산，재차기출상측산출본차대장암사사공작단례암증환자적검출성본，병대본차사사인군전병정치료비용여비사사인군진행비교분석。결과재12953명조사대상중，공관찰도대장암암전병변71례，암전병변검출솔546.2/10만；암증9례，검출솔69.2/10만。북경대장암사사항목적직접투입비용위227136.80원，사사대상교통투입0.42만원，사사출1례대장암환자적검출성본추산약위1.99만원。본차사사인군대장암전병정치료비용분별위84.28만원，비사사인군위120.28만원，사사인군대장암질병진료비용비비사사인군저12.87만원。결론이장경위주요사사수단적대장암사사공작가이감경사회적의료위생경제부담。
Objective To conduct with a cost analysis of the colorectal neoplasm screening program in Beijing, and provide data evidence for decision making. Methods Based on stratified cluster sampling method, we carried out a 2-stage colorectal neoplasm screening program within 6 districts, Dongcheng, Xicheng, Chaoyang, Haidian , Fengtai and Shijingshan, of Beijing city between October, 2012 to May. 2013. The first stage of the program was to conducting a cancer risk level evaluation for community residents who were forty years older and the second stage's task was to providing clinical exam for those high risk people who were selected from the first stage. There were about 12 953 residents were involved in this program. We calculated the main cost of the colorectal neoplasm screen program in Beijing. Then estimate the cost of detecting one Colorectal Neoplasm patient of this program and compare it with the total treatment cost for a patient. Result 2 487 high risk residents were selected by the first stage and 1 055 of them made appointment for the colonoscopy exam but only 375 accepted the exam, participate rate was 35.5%. 9 neoplasm cancer patients and 71 pre-cancer patient were found at the second stage, the detection rate were 69.2/100 000 and 546/100 000, respectively. The direct input for this neoplasm screening program was 227 100 CNY and the transport expense was 4 200 CNY in the calculations. The cost for detecting one cancer patient was about 19 900 CNY. Comparing with the total medical care cost of a cancer patient (1 282 800 CNY), especially for those have been diagnosed as middle to end stage cancer, the screening program(cost 842 800 CNY) might help to reduce the total health expenditure about 128 700 CNY, based on 12 953 local residents age above 40 years old. Conclusion An colonoscopy based colorectal neoplasm screening program showed its function on medical expenditure saving and might have advantage on health social labor creating.