第49届欧洲糖尿病研究协会年会(EASD2013)于9月23-27日在西班牙巴塞罗那召开。当地时间9月25日下午，“Prevalence and incidence of diabetes”壁报专场上，一项研究报告指出，从性能上比较，空腹毛细血管血糖（FCG）试验更适合作为中国初级保健机构诊断糖尿病的一线筛查工具，但从成本-效益和可行性上表，中国人糖尿病风险评分（DRS）更优。
该研究目的是在中国初级保健机构评价确诊糖尿病的两种筛查方法的性能及成本-效益。研究在初级保健机构将空腹毛细血管血糖（fasting capillary glucose，FCG）试验或中国人糖尿病风险评分（diabetes risk score，DRS）这两种筛查方法与随后的糖尿病诊断试验进行比较。采用ROC曲线分析评价FCG和DRS这两种筛查方法的性能。主要的经济学结果指标包括：筛查每1000人的总成本、未确诊糖尿病患者的比例以及从社会角度而言筛查糖尿病患者的人均费用。
结果显示，按照空腹血糖≥7.0 mmol/L，和/或2小时血浆
结论认为，在中国的初级保健机构，作为诊断糖尿病的一线筛查工具，FCG试验的性能略优于DRS。而DRS因其非创伤性的和非专业导向性，在成本-效益和可行性方面更优。
| Evaluation of two screening methods for newly diagnosed diabetes in China: a cost-effectiveness study（中国新诊断糖尿病患者两种筛查方法的评价：一项成本-效益研究） |
| Background and aims: To evaluate the performance and cost-effectiveness of two screening methods to identify undiagnosed diabetes at primary care settings among a Chinese population. Materials and methods: Two screening methods using a fasting capillary glucose (FCG) test or a Chinese diabetes risk score (DRS) at primary care settings followed by diagnostic tests were compared. The performance of FCG and DRS was evaluated by using receiver operating characteristic (ROC) curve analysis. The main economic outcome measures were the total cost of screening per 1000 persons, proportion of undiagnosed diabetes detected, and the cost per undiagnosed diabetes identified from the societal perspective. Results: Among all participants, 26.6% (2453/9208) had undiagnosed diabetes defined by fasting plasma glucose≥7.0 mmol/l and/or 2hour plasma glucose≥11.1 mmol/l and/or hemoglobin A1c≥6.5%. At the optimal cutoff point of 6.2 mmol/l for FCG and 14 for DRS, the sensitivity was 42.7% and 62.5%, and specificity was 75.4% and 57.0%, respectively. The area under the ROC curve was 67.7% for FCG and 62.4% for DRS (P<0.001). Based on the input costs, the total cost of screening 1000 persons was ¥56000 ($8000) for FCG and ¥77000 ($11000) for DRS. The cost per case identified was ¥491 ($70) for FCG and ¥463 ($66) for DRS, at the optimal cutoff points. Conclusion: As a first-line screening tool for undiagnosed diabetes, the FCG test performed slightly better than the DRS in primary care settings in China. The non-invasive and layperson-oriented DRS was more cost-effective and feasible. |
点击进入>>EASD2013年会专题
我要投稿
