Lung Cancer Screening And Health Economics Analysis In Hebei Province

Part one: Two lung cancer screening models in Hebei provinceObjective: The results of two lung cancer screening models in Hebei province were analyzed.Methods: Lung cancer screening models(urban cancer model and hospital medical examination center lung cancer screening model)of Hebei Province were evaluated.The urban cancer model recruited specific community population and assessed the high-risk of lung cancer through questionnaire,and then the high-risk group was further screened by low-dose spiral CT(LDCT).This study included lung cancer screening population who participated in the Hebei Urban Cancer Early Diagnosis and Early Treatment Project from November 2016 to May 2019.The physical examination model was a group of people recruited at a physical examination center of provincial tumor hospital to conduct lung cancer screening through LDCT.This study included people who were screened for lung cancer at a medical examination center from January 2016 to December 2018.The two groups of people learned about the incidence of lung cancer through a combination of active follow-up and passive follow-up,and performed epidemiological analysis and clinical characteristics comparison of confirmed lung cancer patients.Results:1.By analyzing two lung cancer screening models in Hebei Province,with 13570 people in high-risk group of urban cancer modle with LDCT,and 1874 cases were detected lung-positive nodules,with detection rate of 13.81%.A total of 85 lung cancer patients were found underwent follow-up,with incidence rate of 0.63%.77590 people were evaluated as non-high-risk group of the urban cancer modle,and 63 patients with lung cancer were found underwent follow-up,with incidence rate of 0.08%.In the physical examination modle,6200 people underwent LDCT,and 651 lung-positive nodules were detected,with detection rate of 10.50%.29 lung cancer patients were found and with an incidence rate of 0.47% in physical examination modle.2.Analysis of epidemiological factors of lung positive nodules detected in urban cancer modle and physical examination model,we found that age,education level,smoking status,second-hand smoke exposure,long-term air pollution,exercise,mental trauma,mental depression,drinking,tea drinking,exposure to harmful substances,history of chronic respiratory diseases,family history of cancer have statistical significance.3.Analysis of epidemiological factors of lung cancer patients diagnosed in three groups(high-risk population,non-high-risk population and physical examination population)under two lung cancer screening models,we found that age,education level,smoking status,second-hand smoke exposure,exercise,mental trauma,mental depression,drinking,tea drinking,exposure to harmful substances,history of chronic respiratory diseases,family history of cancer have statistical significance among the three groups.4.Both the urban cancer model and the physical examination model could increase the detection rate of early lung cancer significantly if used LDCT examination.The proportion of stage I lung cancer was 37.10% higher in high-risk group(82.81%)than in non-high-risk group(45.71%),and the proportion of stage I lung cancer in physical examination group(82.14%)was 36.43% higher than in non-high-risk group(45.71%).Part two: Markov model was used to analyze the health economics of lung cancer screening model in Hebei provinceObjective: A health economics analysis of lung cancer screening in urban cancer model and physical examination model of Hebei province,with a view to provide scientific basis for the allocation of health resources for lung cancer prevention and treatmentMethods: Based on the Markov model,the initial population distribution was determined through two lung cancer screening models.The relevant parameter information was obtained by referring to literature studies,the SEER database and the World Bank database.Simulate 100,000 high-risk group and physical examination group over the age of 40,with different screening cycles(every 1 year,every 2 years,every 3 years,and every 5 years)over the next 30 years.Based on the results of cost-effectiveness analysis and cost-benefit analysis,eight screening schemes of four screening cycles under the two screening modes were compared.Results:1.Simulating the urban cancer model and physical examination model,the morbidity and mortality of lung cancer have decreased after the population screening intervention treatment,among which the urban cancer model and physical examination model have the most significant reduction in the mortality rate every 1 year,which decreased by 18.38% and 14.03%,respectively.2.An economic analysis of the urban cancer model and the physical examination model,both models have the best cost-effectiveness ratio of screening every 2 years.In this scheme,the urban cancer model cost of saving a life-year(69063.54 RMB)is lower than the cost of a physical examination model(83680.32 RMB).3.Incremental cost-effectiveness analysis shows that screening for the urban cancer model every 5 years has the best effect,and it costs 52191.99 yuan to save an extra life year;the physical examination model has the best effect every 3 years,and it will cost 76439.24 yuan to save an extra life year.The urban cancer model and physical examination model have positive costeffectiveness in different screening cycles.The benefits of the urban cancer model and the physical examination model are 1.50 times and 1.19 times of screening every 2 years,respectively.