目的系统评价中国人群肝癌筛查卫生经济学研究现状,为后续进一步开展相关研究提供依据。方法计算机检索 PubMed、EMbase、The Cochrane Library、Web of Science、CNKI、WanFang Data、CBM 和 VIP 数据库,搜集我国人群肝癌筛查卫生经济学研究,检索时限均从建库至 2017 年 12 月 31 日。由 2 位研究者独立筛选文献、提取资料,对纳入研究基本特征、卫生经济学评价方法及主要结果等进行描述性分析,并对研究质量及报告规范性进行评价。结果共纳入 5 个研究。纳入研究的肝癌筛查起始年龄在 35~45 岁,筛查技术多选用甲胎蛋白(AFP)联合超声,频率以每半年 1 次居多。5 个研究整体质量尚可;整体报告规范性尚可,得分中位数为 78%(60%,78%)。2 个研究报道了基于每检出 1 例肝癌的成本,分别为 4.4 万元和 57.5 万元。3 个研究报道了基于挽救生命年(LYS)和质量调整生命年(QALY)的成本-效果比(CER)指标,仅 1 个中国内地研究报道了每挽救一个 LYS 的成本,为 1 775 元,其与当地人均国内生产总值(GDP)比值为 0.1;另 2 个我国台湾地区的研究报道了 4 组筛查的成本-效果比,其与当地人均 GDP 比值范围为 1.0~2.2。结论肝癌高发地区我国台湾地区研究提示在普通人群中开展肝癌筛查经济有效;而我国大陆研究提示在高危人群中开展 AFP 联合超声筛查经济有效,但仅有 1 个地区性研究支持,仍需更多基于随机对照试验或队列研究的卫生经济学评价予以验证。

ObjectiveTo systematically review the status of economic evaluation of liver cancer screening in China, so as to provide reference for further studies.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, CBM and VIP databases were searched to collect economic evaluation studies of liver cancer screening in China from inception to December, 2017. Two reviewers independently screened literature, extracted data and conducted descriptive analysis of basic characteristics, methods of economic evaluation and main results as well as quality and uniformity of reporting.ResultsA total of 5 studies were included. Among them, the starting age of screening were found to be 35 to 45 years old; α-fetoprotein (AFP) testing and ultrasound examination combined procedure and screening interval of every 6 months were mostly evaluated. The quality of the 5 studies was satisfactory, and the uniformity of reporting was relatively acceptable, with a median score of 78% (range: 60% ~ 78%). Two population-based studies reported cost per liver cancer detected (44 thousand and 575 thousand yuan). Three studies reported cost-effectiveness ratio(CER) based on life year saved (LYS) and quality adjusted life year (QALY). Among these results, only 1 study from mainland China reported CER based on LYS (1 775 yuan), and the calculated ratio of CER to local GDP per capita was estimated as 0.1, while 2 studies from Taiwan province reported 4 CERs, and the ratios of CER to local GDP per capita ranged from 1.0 to 2.2.ConclusionsInformation from liver cancer endemic areas such as Taiwan province indicates promising cost-effectiveness to conduct liver cancer screening in local general population, while data from mainland suggests that conducting liver cancer screening combining AFP and ultrasound in high-risk population will be cost-effective, however only supported by 1 regional study. This needs to be verified by further economic evaluations based on randomized controlled trials or cohort studies as well as health economic evaluations.

关键词: 肝癌; 筛查; 卫生经济学评价; 成本-效果分析; 系统评价; 中国

Key words: Liver cancer; Screening; Health economic evaluation; Cost-effectiveness analysis; Systematic review; China

引用本文: 白方舟, 王乐, 王宇婷, 黄慧瑶, 刘成成, 朱娟, 任建松, 赵建军, 韩优莉, 曲春枫, 代敏, 石菊芳. 中国肝癌筛查卫生经济学研究的系统评价. 中国循证医学杂志, 2018, 18(5): 442-449. doi: 10.7507/1672-2531.201802028 复制

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