结核与肺部疾病杂志2026，Vol.7Issue(2)：179-185,7.DOI:10.19983/j.issn.2096-8493.20250199
基于决策树Markov模型的非吸烟女性肺癌筛查卫生经济学分析
Health economics analysis of lung cancer screening using low-dose computed tomography in non-smoking women based on a decision tree-Markov model
摘要
Abstract
Objective:To evaluate the health economic value of lung cancer screening strategies in non-smoking women based on a decision-tree Markov model,to identify the optimal screening strategy to guide policy-making for lung cancer screening.Methods:A decision-tree Markov model for lung cancer screening strategies in non-smoking women aged 50-74 years was constructed using TreeAge Pro 2022 software.The parameters included epidemiological data(incidence and mortality rates),disease transition probabilities,screening and diagnostic performance parameters(modality,starting age,and screening interval),costs and health utility values.These parameters were derived from the China Cancer Registry Annual Report,the China Population Census Yearbook 2020,the 2018 China Adult Tobacco Survey Report,and high-quality published literature from both domestic and international sources.Then simulations were conducted for 100 000 individuals each undergoing various low-dose computed tomography(LDCT)screening strategies(screening group)and those not receiving any lung cancer screening(non-screening group).Cost-utility analysis(including indicators such as 2021 gross domestic product(GDP),willingness to pay(WTP),incremental cost-utility ratio(ICUR),quality-adjusted life years(QALY),and life years(LY))and sensitivity analysis were subsequently performed.Results:Among the lung cancer screening strategies evaluated,all 12 single LDCT screening strategies demonstrated higher per-capita costs(range:3355.64-10 761.40 yuan)compared with the 12 strategies combining the NCC-LCm2021 model with LDCT(range:1580.48-3287.68 yuan).The annual single LDCT screening strategy for the population aged 50-74 years had the highest per-capita cost(10 761.40 yuan),while the strategy of conducting NCC-LCm2021 combined with LDCT screening every 5 years for the population aged 60-74 years had the lowest per capita cost(1580.48 yuan).When applying a three times the per-capita GDP(2021 year:242 928 yuan)as the WTP threshold,all screening strategies exhibited cost-utility advantages,with ICUR ranging from 69 965.507 yuan/QALY to 158 106.667 yuan/QALY.The annual single LDCT screening for the 50-74 years age group was the most cost-effective strategy,yielding 17.173 LY and 16.062 QALY,with an ICUR of approximately 69 965.507 yuan/QALY.Sensitivity analysis showed that the ICUR value of generated between 1 and 3 times of the per capita GDP(2021 year)threshold,and the probability of having a cost-effectiveness advantage was 92％.Conclusion:The NCC-LCm2021 model combined with LDCT for lung cancer screening in non-smoking women incurs lower per-capita costs than single LDCT screening.However,with 3 times the per-capita GDP as the WTP threshold,annual single LDCT screening for the population aged 50-74 years represents the most cost-effective strategy,and has good robustness.Therefore,this strategy is recommended as the priority strategy for lung cancer screening in non-smoking women.关键词
烟草,非吸烟/肺肿瘤/病人识别系统/妇女卫生保健服务/模型,经济学/成本及成本分析Key words
Tobacco,smokeless/Lung neoplasms/Patient identification systems/Women's health services/Models,economic/Costs and cost analysis分类
医药卫生引用本文复制引用
刘玲丽,刘盛元,杨亚蕊,覃紫菱,郭旭君,钟涛,范玉铮,何娟,刘俊,徐明明..基于决策树Markov模型的非吸烟女性肺癌筛查卫生经济学分析[J].结核与肺部疾病杂志,2026,7(2):179-185,7.基金项目
癌症、心脑血管、呼吸和代谢性疾病防治研究国家科技重大专项(2024ZD0524800,2024ZD0524804) （2024ZD0524800,2024ZD0524804）
南山区科技计划项目(医疗卫生类)[NS2025015(重点),NS2024036] （医疗卫生类）
广东省医学科学技术研究基金项目(A2023158,C2023106) （A2023158,C2023106）
南山区区级医学重点学科建设项目 National Major Scientific and Technological Special Project for Cancer,Cardiovascular and Cerebrovascular,Respiratory,and Metabolic Disease Prevention and Treatment Research(2024ZD0524800,2024ZD0524804) （2024ZD0524800,2024ZD0524804）
Nanshan District Science and Technology Program(Medical and Health Category)(NS2025015,Key Program （Medical and Health Category）
NS2024036) （）
Guangdong Medical Science and Technology Research Fund Project(A2023158,C2023106) （A2023158,C2023106）
Nanshan District Medical Key Discipline Construction Funding （）
