城市上消化道癌高危人群对内镜筛查的接受度与支付意愿
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摘要
[目的]调查我国城市上消化道癌高危人群对内镜筛查的接受度与支付意愿。[方法]基于2012～2014年城市癌症早诊早治项目的 13个省份,以高危风险模型筛查出的上消化道癌高危人群且接受进一步单一上消化道癌内镜筛查的居民为对象,面对面调查其对内镜筛查的接受度和在一定付费假设下的支付意愿,并进行分省份亚组分析。[结果]最终纳入分析对象共3256名。年龄(55.4±7.5)岁,男性占40.8%,近5年中位人均年收入为2.3万元。对于上消化道癌内镜筛查,90.0%的高危对象表示可以接受。假定将每3年1次的上消化道癌内镜筛查长期推行且需个人部分付费时,81.7%的高危对象表示愿意支付,但支付额度超过100元者仅占14.8%。其余18.3%无支付意愿者主要认为费用难以承受(38.2%)和检查痛苦(27.3%)。各省份间接受度和支付意愿存在统计学差异(P<0.05)。[结论]我国城市上消化道癌高危人群对内镜筛查的接受度和支付意愿较高,但支付额度较低,提示应提高居民对内镜筛查认知和自我健康的责任意识,改善筛查环境和技术操作以减轻被筛者不适。
[Purpose] To survey the acceptance and willingness-to-pay for endoscopic screening of upper Digestive tract cancer among high-risk populations in urban China. [Methods] From 2012 to 2014,a Cancer Screening Program in Urban China(CanSPUC) was initiated in 13 provinces,the current survey was conducted among those participants who were identified as high risk for upper gastrointestinal cancer by a risk-factor-evaluation-model(community-based) and then went through an endoscopic screening procedure(hospital-based). Data were obtained through a face-to-face questionnaire interview,mainly focusing on the acceptance and willingness-to-pay under certain self-payment assumption for endoscopic screening. [Results] The current analysis included a total of 3256 participants,with an average age of(55.4±7.5) years and median annual income per capita in recent 5 years of 23 thousand Chinese Yuan(CNY),40.8% of whom were males. Of all the participants,90.0% could totally or substantially accept the endoscopic screening. When the endoscopic screening was assumed to take every 3 years with a self-paid pattern,81.7% of participants had the willingness-to-pay,but only 14.8% of them would like to pay more than 100 CNY. The remaining 18.3% of participants showed no willingness-to-pay,and the main reasons were unaffordable expenditure(38.2%) and pain from endoscopic screening(27.3%). There was significant difference in acceptance and willingness-to-pay among provinces. [Conclusion] The acceptance for upper gastrointestinal cancer endoscopic screening among the selected high-risk populations is considerable. The willing-to-pay is relatively high but the amount of payment is limited and low,indicating the necessity of increasing individual's awareness on endoscopic screening and self health responsibility,improving screening environment and procedure to alleviate the discomfort among screened participants.
[Purpose] To survey the acceptance and willingness-to-pay for endoscopic screening of upper Digestive tract cancer among high-risk populations in urban China. [Methods] From 2012 to 2014,a Cancer Screening Program in Urban China(CanSPUC) was initiated in 13 provinces,the current survey was conducted among those participants who were identified as high risk for upper gastrointestinal cancer by a risk-factor-evaluation-model(community-based) and then went through an endoscopic screening procedure(hospital-based). Data were obtained through a face-to-face questionnaire interview,mainly focusing on the acceptance and willingness-to-pay under certain self-payment assumption for endoscopic screening. [Results] The current analysis included a total of 3256 participants,with an average age of(55.4±7.5) years and median annual income per capita in recent 5 years of 23 thousand Chinese Yuan(CNY),40.8% of whom were males. Of all the participants,90.0% could totally or substantially accept the endoscopic screening. When the endoscopic screening was assumed to take every 3 years with a self-paid pattern,81.7% of participants had the willingness-to-pay,but only 14.8% of them would like to pay more than 100 CNY. The remaining 18.3% of participants showed no willingness-to-pay,and the main reasons were unaffordable expenditure(38.2%) and pain from endoscopic screening(27.3%). There was significant difference in acceptance and willingness-to-pay among provinces. [Conclusion] The acceptance for upper gastrointestinal cancer endoscopic screening among the selected high-risk populations is considerable. The willing-to-pay is relatively high but the amount of payment is limited and low,indicating the necessity of increasing individual's awareness on endoscopic screening and self health responsibility,improving screening environment and procedure to alleviate the discomfort among screened participants.
引文
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[8]Aerdake·NH,Zhu L.Influencing factors of compliance on upper digestive tract cancer screening[J].China Cancer,2015,24(5):376-379.[阿尔达可·纳汗,朱琳.上消化道癌高危人群筛查的依从性影响因素分析[J].中国肿瘤,2015,24(5):376-379.]
[9]Shao Z,Wei WQ,Wang GQ,et al.Cognitive investigation of early diagnosis and treatment in high risk population of esophageal cancer[J].Journal of Practical Oncology,2002,17(1):68-70.[邵壮,魏文强,王贵齐,等.在食管癌高危人群中进行早诊早治的认知调查[J].实用肿瘤杂志,2002,17(1):68-70.]
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[11]Chen Q,Yu L,Liu SZ,et al.Evaluation of screening for upper digestive tract cancer in Linzhou[J].China Cancer,2018,27(3):192-197.[陈琼,于亮,刘曙正,等.林州市上消化道癌内窥镜筛查效果评价研究[J].中国肿瘤,2018,27(3):192-197.]
[12]Liu ZR,Wei WQ,Huang YQ,et al.Economic evaluation of"Early Detection and Treatment of Esophageal Cancer"[J].Chinese Journal of Cancer,2006,25(2):200-203.[刘肇瑞,魏文强,黄悦勤,等.“食管癌早诊早治方案”的经济学评价[J].癌症,2006,25(2):200-203.]
[13]Zhou TH,Gu XF,Zhu JY,et al.Endoscopic screening of upper digestive tract cancer among high-risk population in Urumqi[J].China Cancer,2017,26(10):781-785.[周天虹,顾晓芬,朱俊宇,等.乌鲁木齐市40~69岁上消化道癌高危人群内窥镜筛查结果分析[J].中国肿瘤,2017,26(10):781-785.]
[14]Wang M,Hao CQ,Zhao DL,et al.Distribution of esophageal squamous cell cancer and precursor lesions in high-risk areas,Linzhou in Henan Province and Feicheng in Shandong Province of China,2005-2009[J].Chinese Journal of Preventive Medicine,2015,49(8):677-682.[王孟,郝长青,赵德利,等.2005-2009年中国食管癌高发区河南省林州市、山东省肥城市食管癌及其癌前病变人群分布研究[J].中华预防医学杂志,2015,49(8):677-682.]
[15]Shi JF,Huang HY,Guo LW,et al.Acceptance and willingness-to-pay for colorectal colonoscopy screening among high-risk populations for colorectal cancer in urban China[J].Chinese Journal of Preventive Medicine,2015,49(5):381-386.[石菊芳,黄慧瑶,郭兰伟,等.我国城市大肠癌高危人群对大肠腔镜筛查的接受度与支付意愿调查[J]中华预防医学杂志,2015,49(5):381-386.]
[16]Dai M,Mao AY,Shi JF.Sustainability of cancer screening program in urban China:a multicenter assessment from service supplier’s and demander’s perspectives[J].Chinese Journal of Epidemiology,2018,39(2):139-141.[代敏,毛阿燕,石菊芳.我国城市地区癌症筛查供需方角度的可持续评估[J].中华流行病学杂志,2018,39(2):139-141.]
[17]Zhu J,Huang HY,Mao AY,et al.Preference on screening frequency and willingness-to-pay for multiple-cancer packaging screening programs in urban populations in China[J].Chinese Journal of Epidemiology,2018,39(2):157-164.[朱娟,黄慧瑶,毛阿燕,等.我国城市居民对多种癌症联合筛查的频率倾向及支付意愿[J].中华流行病学杂志,2018,39(2):157-164.]
[18]Tian YH,Yao HF.Analysis on screening status and desire of cervical cancer and breast cancer among 35-45-yearold rural women in Wuhan City[J].Maternal and Child Health Care of China,2016,31(9):1832-1834.[田幼红,姚汉芬.武汉市20万名35~45岁农村籍妇女乳腺癌和宫颈癌筛查状况及意愿分析[J].中国妇幼保健,2016,31(9):1832-1834.]
[19]Xiang W,Zhao FH,Shi JF,et al.Feasibility of packaging screening for cervical cancer,breast cancer,and reproductive tract infection in a rural area in China[J].Acta Academiae Medicineae Sinicae,2009,31(5):616-619.[向往,赵方辉,石菊芳,等.在农村地区开展子宫颈癌、乳腺癌和生殖道感染联合筛查的可行性[J].中国医学科学院学报,2009,31(5):616-619.]
[20]National Health and Family Planning Commission of the People Republic of China.China’s cancer prevention and treatment three-year action plan(2015-2017)[EB/OL].http://www.nhfpc.gov.cn/jkj/s5878/201509/656437bc5c7e4cd0afb581de85be998a.shtml.[国家卫生和计划生育委员会疾病预防控制局.关于印发中国癌症防治三年行动计划(2015-2017年)的通知[EB/OL].http://www.nhfpc.gov.cn/jkj/s5878/201509/656437bc5c7e4cd0afb581de85be998a.shtml.]
[21]Li ZS,Wang GQ,Zhang PT,et al.China experts consensus on the protocol of early gastric cancer screening(2017,Shanghai)[J].Chinese Journal of Health Management,2018,12(1):8-13.[李兆申,王贵齐,张澍田,等.中国早期胃癌筛查流程专家共识意见(草案)(2017年,上海)[J].中华健康管理学杂志,2018,12(1):8-13.]
[22]Di J,Shannon R,Wu J,et al.Knowledge of cervical cancer screening among women across different socio-economic regions of China[J].PLoS One,2015,10(12):e0144819.
[23]Wang GX,Wei WQ,Qiao YL.The practice and experience of screening and early detection for esophageal cancer[J].China Cancer,2010,19(1):4-8.[王国清,魏文强,乔友林.食管癌筛查和早诊早治的实践与经验[J].中国肿瘤,2010,19(1):4-8.]
[2]Yang ZX,Zeng HM,Xia RY,et al.Annual cost of illness of stomach and esophageal cancer patients in urban and rural areas in China:a multi-center study[J].Chin J Cancer Res,2018,30(4):439-448.
[3]Guo LW,Shi CL,Huang HY,et al.Economic burden of esophageal cancer in China from 1996 to 2015:a systematic review[J].Chinese Journal of Epidemiology,2017,38(1):102-109.[郭兰伟,石春雷,黄慧瑶,等.中国1996-2015年食管癌经济负担研究的系统综述[J].中华流行病学杂志,2017,38(1):102-109.]
[4]Liu Q,Zeng HM,Xia RY,et al.Health-related quality of life of esophageal cancer patients in daily life after treatment:a multicenter cross-sectional study in China[J].Cancer Med,2018,7(11):5803-5811.
[5]Expert Committee of Cancer Screening Program,Expert Panel of Esophageal/Cardiac Cancer Program,Expert Panel of Gastric Cancer Program.Early diagnosis and treatment of upper gastrointestinal cancer screening project[M].Beijing:People’s Medical Publishing House,2014.[癌症早诊早治项目专家委员会,食管癌/贲门癌项目专家组,胃癌项目专家组.癌症早诊早治上消化道癌筛查及早诊早治项目技术方案[M].北京:人民卫生出版社,2014.]
[6]Cancer Foundation of China.Central financial transfer payment project[EB/OL].http://www.cfchina.org.cn/show.php?contentid=223.[中国癌症基金会.中央补助地方公共卫生专项资金癌症早诊早治项[EB/OL].http://www.cfchina.org.cn/show.php?contentid=223.]
[7]Song GH,Meng FS,Chen C,et al.Analysis on the factors influencing the compliance to endoscopic screening for early diagnosis and treatment in high-risk areas of esophageal cancer[J].Chinese Journal of Epidemiology,2009,30(9):977-978.[宋国慧,孟凡书,陈超,等.食管癌高发区早诊早治内镜普查顺应性调查[J].中华流行病学杂志,2009,30(9):977-978.]
[8]Aerdake·NH,Zhu L.Influencing factors of compliance on upper digestive tract cancer screening[J].China Cancer,2015,24(5):376-379.[阿尔达可·纳汗,朱琳.上消化道癌高危人群筛查的依从性影响因素分析[J].中国肿瘤,2015,24(5):376-379.]
[9]Shao Z,Wei WQ,Wang GQ,et al.Cognitive investigation of early diagnosis and treatment in high risk population of esophageal cancer[J].Journal of Practical Oncology,2002,17(1):68-70.[邵壮,魏文强,王贵齐,等.在食管癌高危人群中进行早诊早治的认知调查[J].实用肿瘤杂志,2002,17(1):68-70.]
[10]Dai M,Shi JF,Li N.Design and expectation of cancer screening program in urban China[J].Chinese Journal of Preventive Medicine,2013,47(2):179-182.[代敏,石菊芳,李霓.中国城市癌症早诊早治项目设计及预期目标[J].中华预防医学杂志,2013,47(2):179-182.]
[11]Chen Q,Yu L,Liu SZ,et al.Evaluation of screening for upper digestive tract cancer in Linzhou[J].China Cancer,2018,27(3):192-197.[陈琼,于亮,刘曙正,等.林州市上消化道癌内窥镜筛查效果评价研究[J].中国肿瘤,2018,27(3):192-197.]
[12]Liu ZR,Wei WQ,Huang YQ,et al.Economic evaluation of"Early Detection and Treatment of Esophageal Cancer"[J].Chinese Journal of Cancer,2006,25(2):200-203.[刘肇瑞,魏文强,黄悦勤,等.“食管癌早诊早治方案”的经济学评价[J].癌症,2006,25(2):200-203.]
[13]Zhou TH,Gu XF,Zhu JY,et al.Endoscopic screening of upper digestive tract cancer among high-risk population in Urumqi[J].China Cancer,2017,26(10):781-785.[周天虹,顾晓芬,朱俊宇,等.乌鲁木齐市40~69岁上消化道癌高危人群内窥镜筛查结果分析[J].中国肿瘤,2017,26(10):781-785.]
[14]Wang M,Hao CQ,Zhao DL,et al.Distribution of esophageal squamous cell cancer and precursor lesions in high-risk areas,Linzhou in Henan Province and Feicheng in Shandong Province of China,2005-2009[J].Chinese Journal of Preventive Medicine,2015,49(8):677-682.[王孟,郝长青,赵德利,等.2005-2009年中国食管癌高发区河南省林州市、山东省肥城市食管癌及其癌前病变人群分布研究[J].中华预防医学杂志,2015,49(8):677-682.]
[15]Shi JF,Huang HY,Guo LW,et al.Acceptance and willingness-to-pay for colorectal colonoscopy screening among high-risk populations for colorectal cancer in urban China[J].Chinese Journal of Preventive Medicine,2015,49(5):381-386.[石菊芳,黄慧瑶,郭兰伟,等.我国城市大肠癌高危人群对大肠腔镜筛查的接受度与支付意愿调查[J]中华预防医学杂志,2015,49(5):381-386.]
[16]Dai M,Mao AY,Shi JF.Sustainability of cancer screening program in urban China:a multicenter assessment from service supplier’s and demander’s perspectives[J].Chinese Journal of Epidemiology,2018,39(2):139-141.[代敏,毛阿燕,石菊芳.我国城市地区癌症筛查供需方角度的可持续评估[J].中华流行病学杂志,2018,39(2):139-141.]
[17]Zhu J,Huang HY,Mao AY,et al.Preference on screening frequency and willingness-to-pay for multiple-cancer packaging screening programs in urban populations in China[J].Chinese Journal of Epidemiology,2018,39(2):157-164.[朱娟,黄慧瑶,毛阿燕,等.我国城市居民对多种癌症联合筛查的频率倾向及支付意愿[J].中华流行病学杂志,2018,39(2):157-164.]
[18]Tian YH,Yao HF.Analysis on screening status and desire of cervical cancer and breast cancer among 35-45-yearold rural women in Wuhan City[J].Maternal and Child Health Care of China,2016,31(9):1832-1834.[田幼红,姚汉芬.武汉市20万名35~45岁农村籍妇女乳腺癌和宫颈癌筛查状况及意愿分析[J].中国妇幼保健,2016,31(9):1832-1834.]
[19]Xiang W,Zhao FH,Shi JF,et al.Feasibility of packaging screening for cervical cancer,breast cancer,and reproductive tract infection in a rural area in China[J].Acta Academiae Medicineae Sinicae,2009,31(5):616-619.[向往,赵方辉,石菊芳,等.在农村地区开展子宫颈癌、乳腺癌和生殖道感染联合筛查的可行性[J].中国医学科学院学报,2009,31(5):616-619.]
[20]National Health and Family Planning Commission of the People Republic of China.China’s cancer prevention and treatment three-year action plan(2015-2017)[EB/OL].http://www.nhfpc.gov.cn/jkj/s5878/201509/656437bc5c7e4cd0afb581de85be998a.shtml.[国家卫生和计划生育委员会疾病预防控制局.关于印发中国癌症防治三年行动计划(2015-2017年)的通知[EB/OL].http://www.nhfpc.gov.cn/jkj/s5878/201509/656437bc5c7e4cd0afb581de85be998a.shtml.]
[21]Li ZS,Wang GQ,Zhang PT,et al.China experts consensus on the protocol of early gastric cancer screening(2017,Shanghai)[J].Chinese Journal of Health Management,2018,12(1):8-13.[李兆申,王贵齐,张澍田,等.中国早期胃癌筛查流程专家共识意见(草案)(2017年,上海)[J].中华健康管理学杂志,2018,12(1):8-13.]
[22]Di J,Shannon R,Wu J,et al.Knowledge of cervical cancer screening among women across different socio-economic regions of China[J].PLoS One,2015,10(12):e0144819.
[23]Wang GX,Wei WQ,Qiao YL.The practice and experience of screening and early detection for esophageal cancer[J].China Cancer,2010,19(1):4-8.[王国清,魏文强,乔友林.食管癌筛查和早诊早治的实践与经验[J].中国肿瘤,2010,19(1):4-8.]
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