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

doi:10.12114/j.issn.1007-9572.2023.0420

Chinese General Practice ›› 2024, Vol. 27 ›› Issue (22): 2789-2796.DOI: 10.12114/j.issn.1007-9572.2023.0420

• Article·Chinese General Practice/Community Health Service Research • Previous Articles Next Articles

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

1. Shanghai Community Health Service Center, Fenglin Street, Xuhui District, Shanghai 200030, China
2. Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China
3. Shanghai Xuhui District Health Management and Development Center, Shanghai 200237, China
4. Shanghai Xuhui District Health Commission Supervision Office, Shanghai 200030, China

Received:2023-08-03 Revised:2024-03-26 Published:2024-08-05 Online:2024-05-28
Contact: SHOU Juan

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

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

通讯作者: 寿涓
作者简介:
作者贡献：
苏瑾提出研究目标，负责研究的构思与设计，研究的实施，论文起草与撰写；寿涓负责文章的质量与审校，对文章整体负责；顾文钦、易春涛负责监督管理骨质疏松防治工作的开展；徐莉苹、程莉莉、周鹏负责文献收集与整理；丁宏娟、卫洋洋负责数据统计分析，绘制图表；吴颖华、秦杰、薛斌、魏百川、王谦、彭燕、程毅敏、杨蓝负责研究的实施，数据收集与采集；王磊、祁瑨麟、邵迎、蔡立明负责数据清洗。
基金资助:
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(SHXHZDXK202325); 上海市徐汇区科委重大项目(SHXH202203)

Abstract

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.

Key words: Osteoporosis, Community single disease, Prevention and cure, Cost-effectiveness analysis, Markov model

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。

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

CLC Number:

R 681

SU Jin,SHOU Juan,GU Wenqin, et al. Cost Effectiveness Analysis of the Prevention and Treatment of Osteoporosis among the Entire Population in Fenglin Community, Shanghai Based on Markov Chain[J]. Chinese General Practice, 2024, 27(22): 2789-2796. DOI: 10.12114/j.issn.1007-9572.2023.0420.
苏瑾,寿涓,顾文钦等. 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[J]. 中国全科医学, 2024, 27(22): 2789-2796. DOI: 10.12114/j.issn.1007-9572.2023.0420.

Figures/Tables 9

References 21

[1]	《原发性骨质疏松症诊疗社区指导原则》编写组. 原发性骨质疏松症社区诊疗指导原则[J]. 中国全科医学，2019，22(10):1125-1132. DOI：10.12114/j.issn.1007-9572.2019.00.116.
[2]	胡军，张华，牟青. 骨质疏松症的流行病学趋势与防治进展[J]. 临床荟萃，2011，26(8):729-731.
[3]	刘迅，凌莉，王成，等. 多状态Markov模型在慢性肾脏病分级预后研究中的应用[J]. 第二军医大学学报，2009，30(7):804-807. DOI：10.3724/SP.J.1008.2009.00804.
[4]	蒋新军，江华，李明子，等. 糖尿病患者教育成本效果分析[J]. 中国糖尿病杂志，2018，26(11):964-968. DOI：10.3969/j.issn.1006-6187.2018.11.018.
[5]	中华医学会骨质疏松和骨矿盐疾病分会. 原发性骨质疏松症诊疗指南（2017）[J]. 中国骨质疏松杂志，2019，25(3):281-309. DOI：10.3969/j.issn.1006-7108.2019.03.001.
[6]	周鹏，杨蓝，薛斌，等. 基于双向转诊模式构建社区骨质疏松症防治路径及其意义研究[J]. 中国全科医学，2020，23(5):585-592. DOI：10.12114/j.issn.1007-9572.2020.00.043.
[7]	李戈，张春林，蔡承骅，等. 骨质疏松症药物及健康教育干预策略的成本-效益研究[J]. 中国骨质疏松杂志，2006，12(3):310-312,217. DOI：10.3969/j.issn.1006-7108.2006.03.030.
[8]	冯鑫，高颖，潘雪梅，等. 阿仑膦酸钠预防绝经后妇女骨质疏松性骨折的成本-效用分析[J]. 中国药房，2017，28(17):2313-2318. DOI：10.6039/j.issn.1001-0408.2017.17.03.
[9]	苏晓清，黄乐松，杨洲，等. 阿仑膦酸钠的成本-效果分析[J]. 中国老年学杂志，2013，33(15):3625-3628. DOI：10.3969/j.issn.1005-9202.2013.15.035.
[10]	IGLESIAS C P, TORGERSON D J, BEARNE A, et al. The cost utility of bisphosphonate treatment in established osteoporosis[J]. QJM，2002，95(5):305-311. DOI：10.1093/qjmed/95.5.305.
[11]	SI L, WINZENBERG T M, JIANG Q, et al. Screening for and treatment of osteoporosis：construction and validation of a state-transition microsimulation cost-effectiveness model[J]. Osteoporos Int，2015，26(5):1477-1489. DOI：10.1007/s00198-014-2999-4.
[12]	杨旦红，张伟东. 上海城郊社区高血压患者质量调整生命年及其影响因素研究[J]. 中国全科医学，2014，17(10):1158-1160. DOI：10.3969/j.issn.1007-9572.2014.10.019.
[13]	徐迅，李凡，朱云霞，等. 社区规范化管理对慢性阻塞性肺疾病患者质量调整生命年的影响研究[J]. 中国全科医学，2013，16(9):798-801. DOI：10.3969/j.issn.1007-9572.2013.07.026.
[14]	卞宏毅，郑英杰，曹佳燕. 2013年上海市塘桥社区居民寿命表及去死因寿命表分析[J]. 健康教育与健康促进，2016，11(1):52-57. DOI：10.16117/j.cnki.31-1974/r.201601017.
[15]	官海静，徐菲，刘国恩. 基于EQ-5D量表的质量调整生命年计算方法探讨[J]. 中国卫生经济，2015，34(10):5-8. DOI：10.7664/CHE20151001.
[16]	王俊. 基于Markov模型的糖尿病患者行为干预经济学评价[D]. 合肥：安徽医科大学，2018.
[17]	周挺，官海静，刘国恩，等. 中国普通人群生命质量系统综述[J]. 中国卫生事业管理，2016，33(8):621-623,630.
[18]	BRAZIER J E, GREEN C, KANIS J A, et al. A systematic review of health state utility values for osteoporosis-related conditions[J]. Osteoporos Int，2002，13(10):768-776. DOI：10.1007/s001980200107.
[19]	《中国药物经济学评价指南》课题组，刘国恩，胡善联，等.中国药物经济学评价指南（2011版）[J].中国药物经济学，2011(3):6-9,11-48.
[20]	张丽芳，刘中元，林春梅，等. 我国社区卫生服务中心专科服务开展现状及发展策略[J]. 中国全科医学，2019，22(16):1900-1903. DOI：10.12114/j.issn.1007-9572.2019.00.284.
[21]	沈福来，蔡雨阳，吴建平，等. 社区医疗服务产品属性分析与产品开发路径探索[J]. 中华全科医师杂志，2017，16(3):174-178. DOI：10.3760/cma.j.issn.1671-7368.2017.03.002.

项目	人数	百分比（%）	项目	人数	百分比（%）
性别			年龄段
男	1 110	28.1	85~岁	308	7.2
女	2 845	71.9	80~岁	439	10.2
是否腰背疼痛或全身骨痛			75~岁	486	11.3
否	1 493	38.4	70~岁	775	18.1
是	2 392	61.6	65~岁	970	22.6
有无脆性骨折史			60~岁	549	12.8
否	3 024	77.8	55~岁	320	7.5
是	861	22.2	50~岁	159	3.7
是否明显变矮			45~岁	98	2.3
否	3 049	78.5	40~岁	80	1.9
是	836	21.5	35~岁	50	1.2
是否驼背			30~岁	26	0.6
否	3 419	88.0	25~岁	23	0.5
是	466	12.0	20~岁	10	0.2
首次诊断结果			第二次诊断结果
健康	671	15.6	健康	39	10.8
低骨量	2 038	47.5	低骨量	143	39.5
骨质疏松	1 584	36.9	骨质疏松	180	49.7

项目	人数	百分比（%）	项目	人数	百分比（%）
性别			年龄段
男	1 110	28.1	85~岁	308	7.2
女	2 845	71.9	80~岁	439	10.2
是否腰背疼痛或全身骨痛			75~岁	486	11.3
否	1 493	38.4	70~岁	775	18.1
是	2 392	61.6	65~岁	970	22.6
有无脆性骨折史			60~岁	549	12.8
否	3 024	77.8	55~岁	320	7.5
是	861	22.2	50~岁	159	3.7
是否明显变矮			45~岁	98	2.3
否	3 049	78.5	40~岁	80	1.9
是	836	21.5	35~岁	50	1.2
是否驼背			30~岁	26	0.6
否	3 419	88.0	25~岁	23	0.5
是	466	12.0	20~岁	10	0.2
首次诊断结果			第二次诊断结果
健康	671	15.6	健康	39	10.8
低骨量	2 038	47.5	低骨量	143	39.5
骨质疏松	1 584	36.9	骨质疏松	180	49.7

状态间转移概率	健康	低骨量	骨质疏松
健康	0.915	0.085	0.000
低骨量	0.164	0.656	0.179
骨质疏松	0.000	0.249	0.751

状态间转移概率	健康	低骨量	骨质疏松
健康	0.915	0.085	0.000
低骨量	0.164	0.656	0.179
骨质疏松	0.000	0.249	0.751

时间（年）	健康	低骨量	骨质疏松
0	0.156	0.475	0.369
1	0.271	0.382	0.347
2	0.311	0.360	0.329
3	0.344	0.345	0.312
4	0.371	0.333	0.296
5	0.394	0.324	0.282
6	0.414	0.316	0.270
7	0.431	0.310	0.259
8	0.445	0.304	0.250
9	0.458	0.300	0.243
10	0.468	0.296	0.236
11	0.477	0.293	0.230
12	0.485	0.290	0.225
13	0.491	0.287	0.221
14	0.497	0.285	0.218
15	0.502	0.284	0.215
16	0.506	0.282	0.212
17	0.509	0.281	0.210
18	0.512	0.280	0.208
19	0.515	0.279	0.206
20	0.517	0.278	0.205
21	0.519	0.277	0.204
22	0.521	0.277	0.203
23	0.522	0.276	0.202
24	0.523	0.276	0.201
25	0.524	0.275	0.201
26	0.525	0.275	0.200
27	0.526	0.275	0.200
28	0.526	0.275	0.199
29	0.527	0.274	0.199
30	0.527	0.274	0.199

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

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

RichHTML

PDF

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 9

References 21

Related Articles 15

Recommended Articles

Metrics

Comments

变量	S1→S2	S2→S1	S2→S3	S3→S2
BMI	0.732（0.345~1.551）	1.264（1.056~1.513）^a	0.994（0.828~1.193）	1.040（0.970~1.116）
年龄	1.018（0.918~1.121）	1.010（0.952~1.072）	0.995（0.940~1.054）	0.945（0.906~0.986）^a
性别（以女为对照）	1.065（0.058~19.417）	3.442（1.075~11.016）^a	0.659（0.179~2.426）	0.588（0.143~2.421）
是否腰背疼痛或全身骨痛（以无腰背疼痛或全身骨痛为对照）	2.301（0.129~41.036）	0.351（0.102~1.204）	0.420（0.125~1.408）	0.736（0.357~1.514）
有无脆性骨折史（以无脆性骨折史为对照）	0.605（-0.113~1.123）	0.043（-0.001~8.455）	1.224（0.364~4.114）	1.103（0.542~2.244）
是否明显变矮（以无明显变矮为对照）	0.314（0.008~0.712）^a	0.293（0.003~3.282）	2.222（0.403~1.226）	1.373（0.617~3.055）
是否驼背（以无驼背为对照）	0.331（-0.658~1.670）	3.357（0.414~2.722）	2.077（0.324~13.333）	0.751（0.422~2.329）

年份	门诊总费用	门诊诊疗费	住院费	化验费	药品费	人工成本
2016年	2 700 799.30	1 064 081.33	95 036.98	1 140.00	3 828 123.77	18 000.00
2017年	1 704 195.91	708 693.63	385 442.86	12 600.00		52 500.00
2018年	1 756 943.43	746 943.78	402 038.06	13 305.00		60 000.00
2019年	2 261 160.84	1 161 159.06	430 960.75	13 635.00		36 000.00
2020年	2 476 586.33	1 169 471.88	2 967 879.37	45 230.00		15 000.00
2021年	2 381 951.39	1 273 373.56	2 953 956.47	32 020.00		36 000.00
2022年	1 182 543.29	557 540.96	1 250 644.20	11 645.00		7 500.00
合计	14 464 180.49	6 681 264.20	8 485 958.69	129 575.00	3 828 123.77	225 000.00

[1]	HE Haiyang, YANG Jialing, LEI Xun. Prevalence and Influencing Factors of Osteoporosis in Postmenopausal Women: a Meta-analysis [J]. Chinese General Practice, 2024, 27(11): 1370-1379.
[2]	HUANG Taishuai, CHI Yan, HE Ping, HUANG Guolan, ZUO Yanli. Cost-effectiveness Analysis of GnRH Antagonist Protocol and Short-acting GnRH Agonist Long Protocol in Fresh Embryo Transfer Based on Propensity Score Matching [J]. Chinese General Practice, 2023, 26(30): 3809-3814.
[3]	ZENG Lingfeng, YANG Weiyi, LIANG Guihong, XIAO Xiao, LUO Minghui, PAN Jianke, HAN Yanhong, HUANG Hetao, ZHAO Jinlong, XU Nanjun, ZHOU Guanghui, ZHANG Xianquan, LIANG Weixiong, OU Aihua, LIU Jun, Bone and Joint Professional Committee of Degeneration and Injury of Guangdong Provincial Association of Chinese Medicine. Expert Questionnaire Survey and Result Analysis of TCM Symptom Assessment in High Risk Population of Osteoporosis in Ling-nan Region [J]. Chinese General Practice, 2023, 26(24): 2986-2991.
[4]	MENG Fan, DONG Minjie, GUO Jin, XU Songtao, YAN Wei, GU Jun, CHEN Yirong, YANG Cheng, WANG Jun, XIA Lifang, CHEN Jun, FU Lingjie. Osteoporosis in Community-dwelling Elderly People: Prevalence and Associated Prevention and Control Strategies in General Practice [J]. Chinese General Practice, 2023, 26(22): 2778-2784.
[5]	XU Haina, AN Miaomiao, ZHU Yan, WU Chunyan, RAN Limei. Associations of Muscle and Adipose Tissue with Bone Mineral Density in Premenopausal and Postmenopausal Women Undergoing Physical Examination [J]. Chinese General Practice, 2023, 26(21): 2626-2631.
[6]	Chinese Society of Osteoporosis and Bone Mineral Research. Guidelines for the Diagnosis and Treatment of Primary Osteoporosis (2022) [J]. Chinese General Practice, 2023, 26(14): 1671-1691.
[7]	LIN Yanping, GUO Haiwei, HUANG Jiachun, YUAN Jiayao, LIN Xiancan, WAN Lei, HUANG Hongxing. Association of Osteoporosis with Muscle, Bone and Lipid Related Indices [J]. Chinese General Practice, 2023, 26(09): 1080-1085.
[8]	WANG Xixi, SHEN Rui, WANG Junjie, XU Niying. Best Evidence Summary of Exercise Interventions for Osteoporosis in Postmenopausal Women [J]. Chinese General Practice, 2023, 26(09): 1151-1158.
[9]	LI Shitian, LYU Xiaogang, ZHU Xiaoqi, WANG Jiaye, LU Xiaocui. Association of Sedentary Behavior and Physical Activity with Calcaneal Bone Mineral Density among College Students [J]. Chinese General Practice, 2023, 26(06): 725-733.
[10]	JI Xingchen, WANG Mingxin, CHEN Shaohua, GAO Gai, WU Xiaowan. Associated Factors of Osteoporosis in Postmenopausal Women with Type 2 Diabetic Mellitus in China: a Meta-analysis [J]. Chinese General Practice, 2023, 26(04): 504-511.
[11]	TANG Zhijie, SUN Guozhen, WANG Jie, LIU Shenxinyu, BAO Zhipeng, YANG Gang, WANG Lin. Cost-effectiveness Analysis of Early Screening for Atrial Fibrillation: a Review of Recent Advances [J]. Chinese General Practice, 2023, 26(01): 104-112.
[12]	WEI Xu, LIU Ning, ZHANG Yili, HAN Tao, SUN Kai, QI Baoyu, CHEN Xin, QIN Xiaokuan, GAO Jinghua, XIE Yanming, ZHU Liguo. Comorbidities of Osteoporosis: Recent Advances and Early Screening [J]. Chinese General Practice, 2022, 25(35): 4369-4374.
[13]	ZHANG Yili, HUANG Xinyi, QI Baoyu, SUN Chuanrui, WANG Xiaoyang, WEI Xu, XIE Yanming. Multimorbidity in Elderly Population: Challenges and Coping Strategies [J]. Chinese General Practice, 2022, 25(35): 4363-4368.
[14]	HAN Tao, SUN Kai, SUN Chuanrui, ZHANG Yili, XIE Yanming, SHEN Hao, WANG Xu, QI Baoyu, ZHU Liguo, WEI Xu. Prevalence and Associated Factors of Lumbar Disc Herniation in Osteoporosis: a Cross-sectional Survey [J]. Chinese General Practice, 2022, 25(35): 4375-4380.
[15]	Shufang WANG, Xiuyan WANG, Yuwei YAN, Risu NA, Yuyu HENG, Ruhong WU, Ling JIN, Juan AN, Yan MEI, Xiaochun WU, Zhenqing LIU. Associated Factors of Osteoporosis and Physical Fitness in Elderly Chinese Men [J]. Chinese General Practice, 2022, 25(18): 2188-2193.