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深圳市2型糖尿病患者糖尿病视网膜病变社区筛查策略卫生经济学评价

Health economic evaluation of community-based diabetic retinopathy screening among type 2 diabetes mellitus patients in Shenzhen, China: a Markov model simulation study

    摘要
  • 摘要:
    目的 对广东省深圳市2型糖尿病（T2DM）患者糖尿病视网膜病变（DR）社区筛查策略进行卫生经济学评价，为该筛查策略在深圳市基层医疗卫生机构的推广提供参考依据。
    方法 于2021年8—12月采用两阶段随机抽样方法在深圳市10个行政区中抽取1 200例T2DM患者进行DR社区筛查，并以DR社区筛查为研究策略、不筛查为对照策略，从医疗卫生服务角度构建Markov模型对深圳市DR社区筛查策略进行成本效益分析，估算其成本、效益值和增量成本效益比（ICER），并通过单因素敏感性分析和概率敏感性分析评估结果的稳定性。
    结果 本研究最终对深圳市1 097例T2DM患者进行DR社区筛查，其中患DR者266例，DR患病率为24.3%；通过模拟20个周期进行系统性筛查，不筛查组和筛查组的成本分别为38 882.05和41 920.75元，可分别获得17.13和17.42个质量调整生命年（QALY），ICER值为10 478.28元/QALY；对筛查策略下的收益及成本进行比较，不筛查组和筛查组的净效益（NMB）分别为218 071.06和219 409.58元，DR社区筛查策略的效益成本比（BCR）为5.23，在本筛查策略下每投入1元成本可获益5.23元的间接货币收益；不筛查组和筛查组经过20个周期模拟后失明例数的比例分别为21.0%和10.1%，DR社区筛查约可挽救120例T2DM患者免于因DR导致的失明；单因素敏感性分析结果显示，对ICER影响最大的健康效益值参数和成本参数分别为失明患者的健康效益值和并发糖尿病视黄斑水肿（DME）患者的年治疗成本；概率敏感性分析结果显示，深圳市居民对DR社区筛查具有良好的支付意愿，且DR筛查在支付意愿阈值>10 478.28元/QALY的情况下可带来远大于采取不筛查策略时的收益。
    结论 深圳市DR社区筛查策略具有良好的经济学效益，可在深圳市基层医疗机构进行推广。

     

    Abstract:
    Objective To conduct a health economic evaluation of a community-based screening strategy for diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM) in Shenzhen, Guangdong Province, and to provide evidence for implementation of this screening strategy in primary healthcare facilities in the city.
    Methods Community-based DR screening was conducted from August to December 2021 among 1200 T2DM patients recruited from 10 administrative districts in Shenzhen using a two-stage random sampling approach. A Markov model was constructed from a health care services perspective to conduct a cost-effectiveness analysis of the community-based DR screening strategy, with community-based DR screening as the intervention strategy and no screening as the control. Costs, effect sizes, and incremental cost-effectiveness ratios (ICERs) were estimated. Univariate and probabilistic sensitivity analyses were performed to assess the robustness of the results.
    Results Of the 1 097 participants finally included in the analysis, 266 (24.3%) were diagnosed with DR. Through 20 simulated cycles of systematic screening, the control (no screening) and intervention (screening) groups incurred costs of Chinese Yuan (CNY) 38 882.05 and CNY 41 920.75, respectively, and gained 17.13 and 17.42 quality adjusted life years (QALYs), respectively. The incremental cost-effectiveness ratio (ICER) was CNY 10 478.28/QALY. The net monetary benefits were CNY 218 071.06 and CNY 219 409.58 for the control and intervention groups, respectively, with a benefit-cost ratio of 5.23 for the screening strategy (indicating an indirect return of CNY 5.23 per CNY 1 invested). After 20 simulation cycles, the blindness rate was 21.0% (no screening) versus 10.1% (screening), with screening preventing approximately 120 cases of DR-related blindness in T2DM patients. Sensitivity analyses identified the health utility of blind patients and the annual cost of DME treatment as the most influential parameters. Probabilistic analysis showed good willingness-to-pay (WTP) among T2DM patients in Shenzhen, with screening being cost-effective at WTP thresholds > CNY 10 478.28/QALY.
    Conclusions The results demonstrate that the community-based DR screening strategy for T2DM patients in Shenzhen City is cost-effective and can be promoted in primary healthcare facilities in similar urban settings.

     

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