| Objective: 1. A Markov model was constructed to simulate the disease natural history of low-risk and high-risk colorectal adenomas without any intervention,and to predict the disease outcome of different risk of colorectal adenomas; 2.Combined with the characteristics of natural history of colorectal adenomas and onset of building a Decision Tree- Markov model, applied model analysis method, compared the different risk of colorectal adenomas polypectomy and without any intervention, evaluation of long-term outcome for the treatment of colorectal adenomas; 3. Explored the methodology of application Decision Tree-Markov model to evaluate the long-term effectiveness of the clinical intervention.Methods: Applied Tree Age Pro 2011 to establish Markov model to simulate the 1000 50-year-old patients with low or high risk colorectal adenomas evaluate the progress of the disease in the next 25 years. Then built a Decision Tree- Markov model to evaluate the long-term outcome of polypectomy and without any intervention of 50-year-old patients in the next 25 years. Evaluated the results through Cost-effectiveness analysis, Cost-utility analysis and Cost-benefit analysis,and took a sensitivity analysis about the related parameters.Results: Patients with low-risk adenomas:1.The expectancy life of 50-year-old low-risk adenoma patients was 16.12 years, 13.94 quality-adjusted life years;2.25 years after, the 1000 low risk colorectal adenomas patients,the number of low-risk adenoma state, high-risk adenomas state, colorectal cancer state and state of death were 571, 173, 37 and 219 cases respectively; 3.Cost-effectiveness analysis displayed the cost-effectiveness ratio of endoscopic polypectomy and non-interference were 143.73 yuan/Year and 852.38 yuan/Year,endoscopic treatment group was better than no intervention group;4.Cost-utility analysis displayed the costutility ratio of endoscopic polypectomy and non-interference were 145.65 yuan/QALY and 986.09 yuan/QALY, endoscopic polypectomy group was better than no intervention group;5.Cost-benefit analysis showed: compared with no intervention group,the Benefit-cost ratio of low risk adenomas endoscopic polypectomy was 4.8;6.Sensitivity analysis results showed that:Colorectal cancer treatment costs,the transition probability of low-risk adenomas to high-risk adenomas,and high-risk adenomas to colorectal colorectal had greater impact on the results,the health utility value of colorectal cancer had minimal impact on the results. Patients with high-risk adenomas: 1.The expectancy life of 50-year-old high-risk adenoma patients was13.70 years, 11.36 quality-adjusted life years;2.25 years after the 1000 high-risk colorectal adenomas patients,the number of high-risk adenomas state, colorectal cancer state and state of death were 341,114,545 cases respectively;3.Cost-effectiveness analysis displayed the costeffectiveness ratio of endoscopic polypectomy and non-interference were 238.58 yuan/ Year and 7902.51 yuan/Year,endoscopic polypectomy group was better than no intervention group;4.Cost-utility analysis display the Cost-utility ratio of endoscopic polypectomy and non-interference were 241.78 yuan/QALY and 9642.24 yuan/QALY, endoscopic polypectomy group was better than no intervention group;5.Cost-benefit analysis showed: compared with no intervention group,the Benefit-cost ratio of low risk adenomas endoscopic polypectomy was 34.8;6.Sensitivity analysis results showed that:Colorectal cancer treatment costs,the transition probability of high-risk adenomas to colorectal colorectal and the health utility value of high-risk adenomas had greater impact on the results.The incidence of complications of endoscopic and the cost of treatment of complications had minimal impact on the results.Conclusion: 1. The health economics effect of early detection and treatment of colorectal adenoma was better, it could reduce the incidence of colorectal cancer, increase life expectancy and improve quality of life and reduce the burden of disease in colorectal cancer; 2. High-quality endoscopic polypectomyomy of colorectal adenomas could largely prevent the occurrence of colorectal cancer, especially high risk adenoma.But even if after the high-quality endoscopic polypectomyomy,if withnot regular follow-up,one might still had the probability of colorectal cancer, so after the treatment of colorectal adenoma,patients should be followed up regularly, so that to detect and deal with the recurrent adenoma in time; 3. According to the development of colorectal cancer, using Markov model can comprehensived and reliabled reproduce the natural history of disease in the short term; 4. With one-way sensitivity analysis could find: the model developed in this study was relatively stable,the analysis results were reliable, this study was a valuable exploration about the application of Markov model to evaluate the health economics of interventions. |
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