基于Markov模型的儿童肥胖干预措施的经济学评价研究

In the latest 30 years, the childhood obesity has begun to spread rapidly in China, which not only affects the health of children seriously, but also produces the huge economic burden on social development. It is very necessary to select appropriate intervention measures for childhood obesity and carry out prevention and control intervention as soon as possible, and the scientific economic evaluation can provide important reference for the screening of intervention measures. Markov model has been widely used in the economic evaluation of medical measures, because of its prediction of the distribution of long-term health outcomes from the perspective of population after treatment or intervention. However, the use of Markov model in the field of evaluation intervention on chronic non-communicable diseases is very rarely in China, and there’s even no application in economic evaluation research of child obesity interventions. This study will be based on the "Eleventh Five-Year" national science and technology support program research and investigation of the loss of health-related quality of life caused by obesity, to carry out the economic evaluation study of childhood obesity intervention. By using the multi-state Markov model distribution theory，analyzing and predicting the distribution of long-term health outcomes among different childhood obesity intervention children, calculating the saved QALYs, revealing the characteristics of long-term health outcomes after implementation of different childhood obesity interventions, and clarifying the cost-utility and cost-benefit of different childhood obesity interventions. Provide decision-making basis for the developing and implementation of intervention strategies for childhood obesity in China.

近30年来，我国儿童肥胖开始迅速蔓延，不仅严重影响儿童身体健康，并且给社会发展带来巨大经济负担。选取适宜的儿童肥胖干预措施并尽早开展大规模防控干预至关重要，而科学系统的经济学评价可为干预措施的筛选提供重要参考。Markov模型因其可以从群体角度较好的预测疾病干预治疗后的健康结局分布，而被广泛用于医疗措施的经济学评价研究。但在我国慢性非传染疾病的干预评价领域运用较少，在儿童肥胖干预措施的经济学评价研究中的运用更是空白。本研究将基于“十一五”国家科技支撑计划课题研究及肥胖所致健康生命质量损失调查，深入开展儿童肥胖干预的经济学评价研究。运用多状态Markov模型分布理论，分析预测不同儿童肥胖干预队列人群的远期健康结局分布，计算所挽救QALY, 揭示实施不同儿童肥胖干预措施后远期健康结局的变化特征，阐明不同儿童肥胖干预措施的成本-效用、成本-效益。为我国儿童肥胖干预策略的制定和实施提供决策依据。

近30年来，我国儿童肥胖开始迅速蔓延，不仅严重影响儿童身体健康，并且给社会发展带来巨大经济负担。选取适宜的儿童肥胖干预措施并尽早开展大规模防控干预至关重要，而科学系统的经济学评价可为干预措施的筛选提供重要参考。本研究基于“十一五”国家科技支撑计划课题研究及肥胖所致健康生命质量损失调查，深入开展儿童肥胖干预的经济学评价研究。对包括综合干预、膳食干预及身体活动干预等以学校为基础儿童肥胖干预措施的多中心随机对照研究，分析干预措施的成本效益，为我国制定儿童肥胖的预防控制政策提供相应建议。从社会角度采用标准的成本效益分析方法，考虑成人肥胖相关的干预、医疗花费和生产力损失成本等。以干预措施所产生的额外质量调整生命年(QALY)作为评价健康结果，以干预成本除以节省的总QALY计算成本-效用比(CUR)，干预避免的成本减去干预成本计算净效益，以实施成本与干预措施避免的医疗和生产力损失总成本之比计算成本效益比(CBR)。分析发现，综合干预、膳食干预、身体活动干预措施人均干预成本分别为58.9元、49.2元和49.5元。 综合干预不仅具有成本效益，而且具有净效益。CUR和CBR分别为8561.5元/ QALY和1.2元/ 1元成本，净节约54809.7元。营养教育和体育活动干预的CUR和CBR分别为每QALY 15861.4元、每1元成本0.7元效益、每QALY 21145.0元、每1元成本0.4元效益(以2009元为单位)。经过敏感性分析，综合干预的CBR效果是稳健的。以学校为基础的综合肥胖干预是一项有益的投资，既符合成本效益，又能节省成本。因此，综合干预策略是最适合我国儿童肥胖预防的方法。