中国两种未诊断糖尿病筛查方法的评估：一项成本效益研究。
Evaluation of two screening methods for undiagnosed diabetes in China: an cost-effectiveness study.
作者信息
Zhang Yanlei, Sun Jianping, Pang Zengchang, Gao Weiguo, Sintonen Harri, Kapur Anil, Qiao Qing
机构信息
Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland.
出版信息
Prim Care Diabetes. 2013 Dec;7(4):275-82. doi: 10.1016/j.pcd.2013.08.003. Epub 2013 Sep 8.
AIMS
To evaluate the performance and cost-effectiveness of two screening methods to identify undiagnosed diabetes at primary care settings among a Chinese population.
METHODS
Two screening methods using a fasting capillary glucose (FCG) test or a Chinese diabetes risk score (DRS) at primary care settings followed by diagnostic tests were compared. The performance of FCG and DRS was evaluated by using receiver operating characteristic (ROC) curve analysis. The main economic outcome measures were the total cost of screening per 1000 persons, proportion of undiagnosed diabetes detected, and cost per undiagnosed diabetes identified from the societal perspective.
RESULTS
Among all participants, 14.6% (1349/9232) had undiagnosed diabetes defined by fasting plasma glucose ≥ 7.0mmol/l and/or 2h plasma glucose ≥ 11.1mmol/l and/or hemoglobin A1c ≥ 6.5%. At the optimal cutoff point of 6.1mmol/l for FCG and 14 for DRS, the sensitivity was 65.1% and 65.8%, and specificity was 72.4% and 55.2%, respectively. The area under the ROC curve was 75.3% for FCG and 63.7% for DRS (P<0.001). Based on the input costs, the total cost of screening 1000 persons was ¥64,000 ($9143) for FCG and ¥81,000 ($11,571) for DRS. The average cost per case identified was ¥674 ($96) for FCG at cutoff point of 6.1mmol/l and ¥844 ($121) for DRS at score of 14. The incremental cost per case identified was ¥17,000 ($2429) for DRS compared to FCG. The dominance relations between strategies remained with the changed in sensitivity analysis.
CONCLUSIONS
As a first-line screening tool for undiagnosed diabetes, the FCG test performed better than the DRS in primary care settings in China. The non-invasive and layperson-oriented DRS was feasible and detected more cases but more expensive. No strategy has strong dominance that was both more effective and less costly. The favorable strategy will depend on if the purpose of the screening program is to identify more cases or to have lower cost per case.
目的
评估两种筛查方法在中国人群基层医疗环境中识别未诊断糖尿病的性能和成本效益。
方法
比较了在基层医疗环境中使用空腹毛细血管血糖（FCG）检测或中国糖尿病风险评分（DRS）两种筛查方法，随后进行诊断测试。通过使用受试者工作特征（ROC）曲线分析评估FCG和DRS的性能。主要经济结果指标是每1000人筛查的总成本、检测出的未诊断糖尿病比例以及从社会角度确定每例未诊断糖尿病的成本。
结果
在所有参与者中，14.6%（1349/9232）患有根据空腹血糖≥7.0mmol/l和/或餐后2小时血糖≥11.1mmol/l和/或糖化血红蛋白≥6.5%定义的未诊断糖尿病。在FCG的最佳截断点6.1mmol/l和DRS的14时，敏感性分别为65.1%和65.8%，特异性分别为72.4%和55.2%。FCG的ROC曲线下面积为75.3%，DRS为63.7%（P<0.001）。根据投入成本，FCG筛查1000人的总成本为64,000元（9143美元），DRS为81,000元（11,571美元）。在截断点6.1mmol/l时，FCG识别的每例病例平均成本为674元（96美元），DRS在分数为14时为844元（121美元）。与FCG相比，DRS识别的每例病例增量成本为17,000元（2429美元）。在敏感性分析变化时，策略之间的优势关系保持不变。
结论
作为未诊断糖尿病的一线筛查工具，在中国基层医疗环境中，FCG检测比DRS表现更好。非侵入性且面向外行的DRS是可行的，能检测出更多病例，但成本更高。没有一种策略具有既更有效又成本更低的强大优势。有利的策略将取决于筛查项目的目的是识别更多病例还是降低每例病例的成本。
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