Departments of Gastroenterology and Hepatology.
Gupta Strategists, Ophemert, the Netherlands.
United European Gastroenterol J. 2013 Oct;1(5):335-45. doi: 10.1177/2050640613502337.
Gastroenterology has over the past 30 years evolved very rapidly. The societal benefits to which this has led are incompletely determined, yet form a mandate to determine the need for future innovations and further development of the field. A more thorough understanding of societal benefits may help to determine future goals and improve decision making.
The objective of this article is to determine the societal gains of medical innovations in the field of gastroenterology in the past and future, using peptic ulcer disease as an example of past innovation and the implementation of colorectal cancer screening as an illustration of future gains.
Literature searches were performed for data on peptic ulcer and colorectal cancer epidemiology, treatment outcomes, and costs. National and governmental databases in the Netherlands were searched to obtain the input for calculations of quality-adjusted life years (QALYs), health-adjusted life expectancy (HALE), and the corresponding societal benefit.
Since 1980 the improvements in peptic ulcer treatment have had a limited impact on life expectancy, rising from 83.6 years to 83.7 years, but have led to a yearly gain of 46,000 QALYs, caused by improved quality of life. These developments in the field of peptic ulcer translated into a yearly gain of 1.8 billion to 7.8 billion euros in 2008 compared with the 1980s. Mortality due to colorectal cancer is high, with 21.6 deaths per 100,000 per year in the Netherlands (European Standardized Rate (ESR)). The future implementation of a nationwide call-recall colorectal cancer screening by means of biennial fecal immunochemical testing (FIT) is expected to result in a 50%-80% mortality reduction and thus a gain of an estimated 35,000 life years per year, corresponding to 26,000 QALYs per year. The effects of the implementation of FIT screening can be translated to a future societal gain of 1.0 billion to 4.4 billion euro.
The innovations and developments in the field of gastroenterology have led to significant societal gains in the past three decades. This process will continue in the near future as a result of further developments. These calculations provide a template for calculations on the need for specialist training as well as research and implementation of new developments in our field.
在过去的 30 年中，胃肠病学发展迅速。这带来了哪些社会效益尚不完全确定，但这形成了确定未来创新和进一步发展该领域的必要性。更全面地了解社会效益可能有助于确定未来的目标并改善决策。
本文旨在确定过去和未来胃肠病学领域医学创新的社会效益，以消化性溃疡疾病为例说明过去的创新，以结直肠癌筛查的实施为例说明未来的收益。
对消化性溃疡和结直肠癌的流行病学、治疗结果和成本进行文献检索。在荷兰，对国家和政府数据库进行了搜索，以获取计算质量调整生命年（QALY）、健康调整期望寿命（HALE）和相应社会效益所需的数据。
自 1980 年以来，消化性溃疡治疗的改进对预期寿命的影响有限，从 83.6 岁上升到 83.7 岁，但由于生活质量的提高，每年可获得 46,000 个 QALY。消化性溃疡领域的这些发展在 2008 年与 20 世纪 80 年代相比，每年带来 18 亿至 78 亿欧元的收益。荷兰结直肠癌的死亡率很高，每年每 10 万人中有 21.6 人死亡（欧洲标准化率（ESR））。预计通过每两年进行一次粪便免疫化学检测（FIT）实施全国性结直肠癌召回筛查，将导致死亡率降低 50%-80%，因此每年可获得约 35,000 个寿命年，相当于每年 26,000 个 QALY。FIT 筛查实施的影响可以转化为未来每年 10 亿至 44 亿欧元的社会效益。
过去 30 年，胃肠病学领域的创新和发展带来了重大的社会效益。由于未来的发展，这一过程将在不久的将来继续。这些计算为我们领域的专家培训需求、研究和新发展的实施提供了模板。
