Garattini L, Cainelli T, Tribbia G, Scopelliti D
Centre for Health Economics, Mario Negri Institute for Pharmacological Research, Ranica, Italy.
Pharmacoeconomics. 1996 Feb;9(2):146-55. doi: 10.2165/00019053-199609020-00006.
Public educational campaigns for the early diagnosis of cutaneous melanoma are considered an effective approach in the prevention of this disease, since they increase the number of cases detected early and consequently lengthen patients' life expectancy. We performed an economic evaluation of such a campaign in Bergamo, Italy, in order to quantify its costs and consequences. We used cost-effectiveness analysis to compare the costs and effects of the campaign with those of the 'do nothing' option. The analysis was performed from the perspective of the Italian National Health Service [the Servizio Sanitario Nazionale (SSN)]. Accordingly, only direct costs related to publicly financed healthcare services were considered. No indirect costs or benefits were considered because they are not relevant to the SSN. Incremental analysis was used to obtain results in terms of additional costs per life-year saved (LYS). Overall LYS were quantified by comparing the survival curves for 4 subgroups of patients with different lesional thicknesses at diagnosis ( < 0.76mm, 0.76 to 1.50mm, 1.51 to 3.00mm and > 3.00mm). All costs were estimated in 1993 Italian lire (L). Overall effectiveness amounted to 233.49 LYS. Using a 5% discount rate, the value of effectiveness was 171.3 LYS. The total cost of the educational campaign (i.e. the sum of the organisational and 'induced' costs minus the costs saved) was estimated at L817 million (approximate 1993 exchange rate $US1 = L1573), and L905 million after discounting at a rate of 5%. Thus, using discounted cost and effectiveness data, the cost of the educational campaign was L5.28 million per LYS.
开展公众教育活动以实现皮肤黑色素瘤的早期诊断，被认为是预防该疾病的一种有效方法，因为这会增加早期发现的病例数量，从而延长患者的预期寿命。我们在意大利贝加莫对这样一项活动进行了经济评估，以量化其成本和效果。我们采用成本效益分析方法，将该活动的成本和效果与“不作为”方案进行比较。该分析是从意大利国家医疗服务体系[国家卫生服务局（SSN）]的角度进行的。因此，只考虑与公共资助医疗服务相关的直接成本。未考虑间接成本或效益，因为它们与SSN无关。采用增量分析来得出每挽救一个生命年（LYS）的额外成本方面的结果。通过比较诊断时不同病灶厚度（<0.76mm、0.76至1.50mm、1.51至3.00mm和>3.00mm）的4个患者亚组的生存曲线，对总体LYS进行了量化。所有成本均以1993年意大利里拉（L）估算。总体效果为233.49个LYS。采用5%的贴现率时，效果值为171.3个LYS。教育活动的总成本（即组织成本与“诱导”成本之和减去节省的成本）估计为8.17亿里拉（1993年近似汇率1美元 = 1573里拉），按5%的贴现率贴现后为9.05亿里拉。因此，根据贴现后的成本和效果数据，教育活动的成本为每LYS 528万里拉。
