荷兰和挪威的腹主动脉瘤筛查的成本效益分析。

Cost-effectiveness of screening for abdominal aortic aneurysm in the Netherlands and Norway.

机构信息

Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands.

出版信息

Br J Surg. 2011 Nov;98(11):1546-55. doi: 10.1002/bjs.7620. Epub 2011 Jul 4.

DOI:10.1002/bjs.7620

PMID:21725968

Abstract

BACKGROUND

The aim of this study was to determine the cost-effectiveness of ultrasound screening for abdominal aortic aneurysm (AAA) in men aged 65 years, for both the Netherlands and Norway.

METHODS

A Markov model was developed to simulate life expectancy, quality-adjusted life-years, net health benefits, lifetime costs and incremental cost-effectiveness ratios for both screening and no screening for AAA. The best available evidence was retrieved from the literature and combined with primary data from the two countries separately, and analysed from a national perspective. A threshold willingness-to-pay (WTP) of €20,000 and €62,500 was used for data from the Netherlands and Norway respectively.

RESULTS

The additional costs of the screening strategy compared with no screening were €421 (95 per cent confidence interval 33 to 806) per person in the Netherlands, and the additional life-years were 0·097 (-0·180 to 0·365), representing €4340 per life-year. For Norway, the values were €562 (59 to 1078), 0·057 (-0·135 to 0·253) life-years and €9860 per life-year respectively. In Norway the results were sensitive to a decrease in the prevalence of AAA in 65-year-old men to 1 per cent, or lower. Probabilistic sensitivity analyses indicated that AAA screening has a 70 per cent probability of being cost-effective in the Netherlands with a WTP threshold of €20,000, and 70 per cent in Norway with a threshold of €62,500.

CONCLUSION

Using this model, screening for AAA in 65-year-old men would be highly cost-effective in both the Netherlands and Norway.

摘要

背景

本研究旨在确定对 65 岁男性进行腹主动脉瘤（AAA）超声筛查的成本效益，同时考虑荷兰和挪威的情况。

方法

我们建立了一个马尔可夫模型，以模拟对 AAA 进行筛查和不筛查两种情况下的预期寿命、质量调整生命年、净健康收益、终生成本和增量成本效益比。我们从文献中检索到最佳可用证据，并结合两国的原始数据进行分析，从国家角度进行评估。我们分别使用荷兰和挪威的意愿支付阈值（WTP）为 20000 欧元和 62500 欧元。

结果

与不筛查相比，荷兰的筛查策略额外增加的成本为每人 421 欧元（95%置信区间为 33 至 806 欧元），额外增加的生命年为 0.097 年（-0.180 至 0.365 年），即每增加 1 个生命年的成本为 4340 欧元。挪威的相应值分别为 562 欧元（59 至 1078 欧元）、0.057 年（-0.135 至 0.253 年）和 9860 欧元/生命年。在挪威，结果对 65 岁男性 AAA 的患病率降至 1%或更低较为敏感。概率敏感性分析表明，在荷兰，使用 20000 欧元的 WTP 阈值，AAA 筛查有 70%的可能性具有成本效益；在挪威，使用 62500 欧元的阈值，AAA 筛查有 70%的可能性具有成本效益。