中国全科医学2024,Vol.27Issue(22) :2789-2796.DOI:10.12114/j.issn.1007-9572.2023.0420

基于Markov链的上海市枫林社区骨质疏松全人群防治工作的成本效果分析

Cost Effectiveness Analysis of the Prevention and Treatment of Osteoporosis among the Entire Population in Fenglin Community,Shanghai Based on Markov Chain

苏瑾 寿涓 顾文钦 易春涛 徐莉苹 程莉莉 丁宏娟 周鹏 吴颖华 秦杰 薛斌 魏百川 王谦 彭燕 程毅敏 杨蓝 卫洋洋 王磊 祁瑨麟 邵迎 蔡立明
中国全科医学2024,Vol.27Issue(22) :2789-2796.DOI:10.12114/j.issn.1007-9572.2023.0420

基于Markov链的上海市枫林社区骨质疏松全人群防治工作的成本效果分析

Cost Effectiveness Analysis of the Prevention and Treatment of Osteoporosis among the Entire Population in Fenglin Community,Shanghai Based on Markov Chain

苏瑾 1寿涓 2顾文钦 3易春涛 4徐莉苹 1程莉莉 1丁宏娟 1周鹏 1吴颖华 1秦杰 1薛斌 1魏百川 1王谦 1彭燕 1程毅敏 1杨蓝 1卫洋洋 1王磊 1祁瑨麟 1邵迎 1蔡立明1
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作者信息

  • 1. 200030 上海市徐汇区枫林街道社区卫生服务中心
  • 2. 200032 上海市,复旦大学附属中山医院
  • 3. 200237 上海市徐汇区卫生事业管理发展中心
  • 4. 200030 上海市徐汇区卫生健康委员会监督所
  • 折叠

摘要

背景 随着社区卫生服务综合改革的逐步深化,社区对全人群的单病种防治工作也在不断优化,但目前仍缺乏合适的方法来评价社区防治的成效.目的 通过分析 2016-2022 年度上海市徐汇区枫林街道社区卫生服务中心现有骨质疏松全人群防治措施的成本效果,探究社区单病种全人群防治的初步成效及可能存在的问题.方法 本研究以 4 293 例枫林社区 2016-2022 年度接受骨质疏松防治的社区居民为研究对象进行成本-效果分析.根据骨密度值将研究对象划分为三种状态:健康、低骨量、骨质疏松,以此构建Markov模型,分析不同状态转移的影响因素,并依据Markov模型预测值结合质量调整生命年(QALY)计算QALY增量,统计 2016-2022 年防治工作投入的所有成本,以成本/QALY增量比来评价防治效果,通过文献检索确定的健康效用值和期望寿命计算求得QALY.结果 枫林社区骨质疏松防治总成本为 33 814 102.15 元.第一次诊断时社区骨质疏松防治人群的总QALY为 77 098.288 9,人均均值为 17.959,标准差为 9.34;第二次诊断时防治人群的总QALY为 79 616.936 1,人均均值为 18.546,标准差为9.342,两次诊断QALY的差值为 2 518.647 2.增量成本效果比(ICER)为 2 132.907 0 元/QALY,ICER值小于 1 倍(66 965.10 元)人均GDP,表明干预方案完全具有成本效果.结论 本研究结合Markov模型及QALY对枫林社区持续接受骨质疏松随访管理的人群的防治效果进行了初步评价,结果显示枫林社区的骨质疏松防治干预方案是值得投入的,为后续骨质疏松的精准防治决策提供了一定的依据.

Abstract

Background With the gradual deepening of the comprehensive reform of community health services,the prevention and control of single diseases for the entire population in the community is also constantly being optimized,However,there is still a lack of appropriate evaluation methods in the community to reflect its prevention and control effectiveness evaluation.Objective By analyzing and exploring the cost effect of the existing whole-population prevention and control measures of osteoporosis in Fenglin community,from 2016 to 2022,this paper answers the initial results and possible problems of the whole-population prevention and control of single disease in the community.Methods This study conducted a cost-effectiveness analysis on 4 293 community residents who received osteoporosis prevention and treatment in Fenglin community from 2016 to 2022.Divide the research object into three states based on bone density values:healthy,low bone mass,and osteoporosis,and construct a Markov model to analyze the influencing factors of different state transitions.And based on the predicted values of the Markov model combined with quality adjusted life years(QALY),the increment of quality adjusted life years(QALY)is calculated.All costs invested in prevention and control work from 2016 to 2022 are counted,and the effectiveness of prevention and control is evaluated by the cost/quality adjusted life year increment ratio.Quality adjusted life years(QALY)are obtained by calculating the health utility value and expected life determined through literature search.Results The total cost of osteoporosis prevention and treatment in Fenglin community was 33 814 102.15 yuan.The total quality-adjusted life years of 4 293 community osteoporosis prevention and treatment population were 77 098.288 9 at the first diagnosis,the average per capita was 17.959,and the standard deviation was 9.34.At the second diagnosis,the total quality-adjusted life years were 79 616.936 1,the mean per capita was 18.546,the standard deviation was 9.342,and the difference between the two diagnoses was 2 518.647 2.The incremental cost-effectiveness ratio(ICER)is 2 132.907 0 yuan/QALY,and the incremental cost-effectiveness ratio(ICER)is less than 1 times(66 965.10 yuan)per capita GDP,indicating that the intervention scheme is fully cost-effective.Conclusion This study combined Markov model and quality-adjusted life years(QALY)to make a preliminary evaluation of the prevention and treatment effect of osteoporosis in Fenglin community.The results showed that the intervention program of osteoporosis prevention and treatment in Fenglin community was worth investing,and provided a certain basis for the accurate prevention and treatment decision of osteoporosis in the future.

关键词

骨质疏松/社区单病种/防治/成本效果分析/马尔科夫模型

Key words

Osteoporosis/Community single disease/Prevention and cure/Cost-effectiveness analysis/Markov model

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基金项目

上海市徐汇区医学科技项目(SHXH202019)

上海市徐汇区高原学科建设项目(SHXHZDXK202325)

上海市徐汇区科委重大项目(SHXH202203)

出版年

2024
中国全科医学
中国医院协会

中国全科医学

CSTPCD北大核心
影响因子:2.04
ISSN:1007-9572
参考文献量21
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