| Objective: Screening plays an important role in the early detection,diagnosis,and treatment of diseases.Evaluation of screening programs focuses more on the natural history of the disease and the long-term effects of interventions than on drugs or other treatments.In recent years,more and more attention has been paid to the controversy of over-diagnosis and over-treatment caused by cancer screening,therefore,the cost effectiveness analysis and cost–utility analysis of screening programs in epidemiological studies can provide a scientific basis for public health decision making.The purpose of this study is to evaluate the health economics through the early diagnosis and treatment program and the data of patients’ economic burden,and to evaluate the two strategies of lung cancer screening and unscreening by Markov Model,in decision-making analysis,the influence degree of different pathological stages of lung cancer on health was divided into different states,and the transition probability of each state within a certain period of time was used to simulate the development of lung cancer,the outcome of Lung Cancer Development and medical costs are predicted based on health outcomes and resource consumption in all states.At the same time,based on the item of early diagnosis and early treatment of non-small cell cancer(NSCLC)patients with different clinical stages of lung cancer(NSCLC)postoperative metastasis and survival time analysis of the related factors,the use of the different clinical stages of NSCLC patients prognosis prediction model;To evaluate the effect of lung cancer screening in high-risk population based on Markov Model,and to put forward policy recommendations to improve the prognosis of patients and to carry out early screening of population.Methods:(1)Patients with lung cancer who were diagnosed by screening and underwent surgical treatment from 2008 to 2018 were selected and followed up,and the factors related to postoperative metastasis time and survival time(gender,surgical condition,pathological type,degree of differentiation,Smoking,tumor family,tumor size,postoperative adjuvant radiotherapy,postoperative adjuvant chemotherapy,targeted drug therapy,etc.).The log-rank test and Kaplan-Meier curve method were used to visualize the differences in postoperative metastasis and survival of various factors under different clinical stages,and further Cox regression analysis was performed on variables with statistical significance in univariate analysis;at the same time,based on Cox regression model To draw and predict the nomograms of postoperative metastasis-free survival and overall survival in patients with different clinical stages of NSCLC,and perform internal validation to evaluate the accuracy of prediction.(2)Based on the activity-based costing method,an economical and effective analysis of the intervention strategy of lung cancer low-dose spiral CT lung cancer LDCT screening was carried out.Among them,the expenditure variables of the hospital include medical and health expenditures,financial expenditures,scientific and technological project expenditures,management costs and others,and screen the hospital’s medical behavior cost elements(variables of cost statistics).At the same time,the positive cases screened by some project sites and the cases of hospitalized patients with lung cancer during the same period were selected,and the relevant hospital admission records,hospital charge records and accounting data were reviewed,and a questionnaire survey was conducted on patients to analyze the average and per-time costs of patients.(3)Health utility value was used as a quantitative indicator of quality of life to calculate quality-adjusted life years(QALY),and Tree Age Pro 2021 software was used to construct a Markov model of high-risk lung cancer screening strategies in my country to quantitatively evaluate lung cancer screening versus unscreened lung cancer.Results:(1)A total of 1277 patients with NSCLC were included,50.9% were male,and the median age was 59 years.Follow-up data showed that 41% of patients developed metastasis after operation,the median metastasis-free survival time was 36.8 months,and the 1-,3-,and 5-year metastasis-free survival rates were 61%,43%,and 23%;44.6% of patients died after operation.The overall median survival time was 49.6months,and the 1-,3-,and 5-year overall survival rates were 70%,51%,and 28%.There are differences in the risk factors for metastasis and death affecting patients at different stages.Based on the above independent risk factors,a nomogram prediction model was established to predict the 1,3,and 5-year metastasis-free survival rates of NSCLC patients with different clinical stages.,TNM2 stage: 0.67,TNM3 stage: 0.65,TNM4 stage: 0.67)and the accuracy is higher than that of a single risk factor.In terms of postoperative survival,tumor size(1-2cm/<1cm)and driver gene mutation(yes/no)were protective factors affecting postoperative survival in patients with TNM1 stage;age(>75 years/<60 years),degree of differentiation(Well differentiated/poorly differentiated),driver gene mutation(yes/no),postoperative adjuvant chemotherapy(yes/no)are protective factors affecting postoperative survival in patients with TNM2stage;smoking status(no/yes),driver gene mutation(yes/no)and postoperative metastasis(yes/no)were the protective factors affecting the postoperative survival rate of patients with TNM stage 3;postoperative metastasis(yes/no)was a protective factor affecting the postoperative survival rate of patients with TNM stage 4.Based on the above influencing factors,a nomogram prediction model for predicting the 1-,3-,and 5-year survival rates of NSCLC patients with different clinical stages was established.: 0.71,TNM3 stage: 0.71,TNM4 stage: 0.77)and the accuracy is higher than that of a single influencing factor.(2)According to the results of this study,the cost of lung cancer screening in urban and rural China is 558.43 yuan and 441.25 yuan per capita respectively.The per capita direct medical burden of stage I-IV patients was 51542.07 CNYs,42410.91 CNYs,99716.67 CNYs and 62975.00 CNYs respectively.All kinds of medical and non-medical costs of middle and late-stage patients were higher than those of early-stage patients.(3)The total cost of LDCT screening for lung cancer high-risk groups is 111488.27 CNYs per unit of QALY,of which the incremental cost utility value of urban lung cancer screening is 94781.57 CNYs / QALY and that of rural lung cancer screening is120627.09 CNYs / QALY.LDCT screening in high-risk groups is economically reasonable.The ICER per 100000 people in the screening group was 135995.83 CNYs,169016.29 CNYs in the medical situation and 162022.05 CNYs in the perspective of patients.The icur per 100000 screening population in the screening group was 110587.98 CNYs,137439.30 CNYs in the medical situation and131751.77 CNYs in the perspective of patients.Conclusion: Based on lung cancer screening,there are differences in independent risk factors for postoperative metastasis and survival in patients with different clinical stages,and a nomogram that can predict postoperative metastasis and survival in different clinical stages is established,suggesting that the prognosis of the target population with such risk factors can be individually predicted and early intervention can be carried out,In order to guide clinical practice,select the appropriate treatment plan and follow-up,so as to improve the prognosis and quality of life of patients.All kinds of medical and non-medical costs of middle and late-stage patients were higher than those of early-stage patients.For each additional quality adjusted life year(QALY)in the screening group,the total cost(social perspective)will be 110587.98 yuan.It is necessary to further optimize and adjust the high-risk screening strategy of lung cancer. |
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