CAJ | 학술논문

目的：探讨基于社区的乳腺癌筛查成本预测与控制，为政府制定相关卫生补偿机制提供依据。方法从社会学角度出发，预测基于社区的乳腺癌筛查方案（方案A）的筛查成本，并将其与2009年美国预防服务工作组（ USPSTF）乳腺癌筛查推荐方案及其调整筛查年龄段后的筛查方案（方案B1、B2）、2010年我国农村妇女乳腺癌筛查推荐方案及其调整筛查年龄段后的筛查方案（方案C1、C2）进行比较。采用Treeage Pro 2011软件对基于社区的乳腺癌筛查方案的影响因素进行单因素敏感度分析。结果5种筛查方案的筛查方法实施成本分别为1396.67、7988.73、14643.52、3866.84及4643.26万元；项目管理成本分别为1444.66、785.46、1449.45、1210.53及1453.74万元；筛查对象相关成本分别为2454.84、3410.67、6251.84、6756.10、8112.63万元；总成本分别为5296.17、12184.86、22344.81、14209.63及11833.47万元；人均乳腺癌筛查成本分别为18.44、77.75、77.78、49.46及49.47元/人。单因素敏感度分析显示，钼靶X线摄影仪折旧维修费、全科医生年劳务费、单位乳腺触诊检查时间、乳腺触诊检查后建议钼靶X线摄影率、单位钼靶X线摄影时间对筛查成本的影响较大。结论基于社区的乳腺癌筛查的总成本和人均筛查成本均低于其他4种筛查方案，钼靶X线摄影仪折旧维修费和全科医生年劳务费是筛查成本的主要构成。选择高效、低价、耐用的筛查设备，提高其利用率和完好率，强化人员培训，合理控制检查时间，提高劳动效率是乳腺癌筛查成本控制的重要内容。
목적：탐토기우사구적유선암사사성본예측여공제，위정부제정상관위생보상궤제제공의거。방법종사회학각도출발，예측기우사구적유선암사사방안（방안A）적사사성본，병장기여2009년미국예방복무공작조（ USPSTF）유선암사사추천방안급기조정사사년령단후적사사방안（방안B1、B2）、2010년아국농촌부녀유선암사사추천방안급기조정사사년령단후적사사방안（방안C1、C2）진행비교。채용Treeage Pro 2011연건대기우사구적유선암사사방안적영향인소진행단인소민감도분석。결과5충사사방안적사사방법실시성본분별위1396.67、7988.73、14643.52、3866.84급4643.26만원；항목관리성본분별위1444.66、785.46、1449.45、1210.53급1453.74만원；사사대상상관성본분별위2454.84、3410.67、6251.84、6756.10、8112.63만원；총성본분별위5296.17、12184.86、22344.81、14209.63급11833.47만원；인균유선암사사성본분별위18.44、77.75、77.78、49.46급49.47원/인。단인소민감도분석현시，목파X선섭영의절구유수비、전과의생년노무비、단위유선촉진검사시간、유선촉진검사후건의목파X선섭영솔、단위목파X선섭영시간대사사성본적영향교대。결론기우사구적유선암사사적총성본화인균사사성본균저우기타4충사사방안，목파X선섭영의절구유수비화전과의생년노무비시사사성본적주요구성。선택고효、저개、내용적사사설비，제고기이용솔화완호솔，강화인원배훈，합리공제검사시간，제고노동효솔시유선암사사성본공제적중요내용。
Objective To study the estimate and control of the cost of community-based breast cancer screening,in order to provide references for making the mechanism of health care reimbursement by government. Methods The cost of community-based breast cancer screening scheme ( scheme A ) was estimated from the perspective of sociology and was compared with that of the breast cancer screening scheme recommended by USPSTF in 2009(scheme B1),the adjusted version of scheme B1 adjusted by age(scheme B2),China rural breast cancer screening scheme recommended in 2010(scheme C1) and the adjusted version of scheme C1 adjusted by age(scheme C2). Treeage Pro 2011 software was employed to conduct single-factor sensitivity analysis of the influencing factors for community-based breast cancer screening. Results The implementation cost of the five schemes was 13 966. 7,79 887. 3,146 435. 2,38 668. 4 and 46 432. 6 thousand yuan respectively;the scheme management cost was 14 446. 6,7 854. 6,14 494. 5,12 105. 3 and 14 537. 4 thousand yuan respectively;the relevant cost of screening objects was 24 548. 4,34 106. 7,62 518. 4,67 561. 0,81 126. 3 thousand yuan;the total cost was 52 961. 7, 121 848. 6,223 448. 1,142 096. 3,and 118 334. 7 thousand yuan respectivey. The average cost of breast cancer screening per person was 18. 44,77. 75,77. 78,49. 46 and 49. 47 yuan respectively. The single - factor sensitivity analysis showed that depreciation and maintenance cost of molybdenum target X-ray camera,the yearly cost of general practitioners,the mammary gland palpation and inspection time per person,the rate of molybdenum target X-ray photography recommended after mammary gland palpation and inspection and the unit time of molybdenum target X-ray photography have significant influences on the cost of screening. Conclusion The general cost and the cost per person of community-based breast cancer screening are lower than other four schemes,and depreciation and maintenance cost of molybdenum target X-ray camera and the yearly cost of general practitioners are the major constitutes of the screening cost. Applying high - efficiency, low - price and durable screening equipments,improving the equipments' usage rate and serviceability rate, strengthening personnel training, controlling inspection time rationally,improving the efficiency of labor are the major contents of the cost control of breast cancer screening.