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目的:从卫生经济学角度探索基于家庭医生签约服务的慢性阻塞性肺疾病（简称慢阻肺）筛查的成本效果和成本效益。方法:2023年1—10月，采用立意抽样、横断面调查的方法选取1 040例在上海市闵行区华漕、古美社区卫生服务中心体检的、年龄60~75岁的老年人为研究对象。研究对象分为对照组与观察组，对照组532名，采用常规社区宣教、体检中心为主导的方式开展慢阻肺筛查；观察组508名，采用紧密医联体支持下的家庭医生为主导的服务方式开展筛查，两组筛查内容均包括评估问卷初筛、复筛、肺功能检查、支气管舒张试验、CT检查等；比较两组的筛查依从率、阳性率及成本效果、成本效益，评价筛查成效。结果:通过初筛及复筛，查见两组对象慢阻肺高危人群及患者合计251例，占24.13%，其中高危人群222例，占比21.35%，确诊患者29例，占比2.79%。观察组问卷初筛、复筛、肺功能检查、支气管舒张试验、确诊及后续CT检查的依从率均明显优于对照组（ χ2=33.563、41.425、24.842、17.363，均 P<0.05）。两组对象筛查发现的高危人群及患者占比有明显差异，观察组高危人群及患者占比较高（ χ2=44.880，均 P<0.05）。观察组问卷初筛、肺功能检查、支气管舒张试验、CT检查的阳性率均明显高于对照组（ χ2=29.191、11.313、12.370、4.429，均 P<0.05）。对照组、观察组筛查的成本分别为3.61万元、5.39万元，两组总计9.00万元。对照组、观察组复筛项目中的肺功能检查费的成本分别为1.44万元、2.45万元，合计3.89万元，占比43.19%，在各项成本中占比最高。对照组、观察组及全体对象每发现并筛出1例慢阻肺高危人群及患者的人均成本分别为429.45元、322.75元、358.46元；两组初筛、复筛人均成本的比较显示，观察组人均成本明显低于对照组（ χ2=20.396， P<0.05）。两组对象合计的人均净效益为0.37万元，效益成本比为43.50。观察组、对照组的人均净效益分别为0.49万元、0.26万元，观察组的人均净效益较对照组高0.23万元；观察组、对照组的效益成本比分别为46.77、38.61，观察组的效益成本比较对照组高8.16。 结论:基于家庭医生签约服务的慢阻肺筛查效果显著，筛查依从性提升明显，具有较高的成本效益。

Objective:To explore the cost-effectiveness and cost-benefit of chronic obstructive pulmonary disease (COPD) screening and intervention based on family doctor contract services.Methods:From January 2023 to October 2023, using purposive sampling and a cross-sectional survey method, 1 040 individuals aged 60 to 75 years who underwent physical examinations at community health service centers in Shanghai Minhang district were selected as research subjects. The subjects were divided into a control group ( n=532) and a study group ( n=508). The control group received conventional community health education and participated in a COPD screening and intervention program provided by the examination center. The study group received COPD screening and intervention provided by contracted family doctors under a tightly integrated medical consortium. The screening content for both groups included initial and follow-up risk assessment questionnaires, pulmonary function tests, bronchodilator tests, and CT scans. A comparative analysis was conducted on the screening compliance rate, positive rate, and cost-effectiveness and cost-benefit between the two groups. Results:A total of 251 individuals at high risk for COPD and confirmed COPD patients were identified through initial and re-screening in both groups, accounting for 24.13% of the subjects, including 222 individuals at high risk (21.35%) and 29 confirmed patients (2.79%). The study group had significantly higher compliance rates in questionnaire-based initial screening, questionnaire-based re-screening+pulmonary function tests, bronchodilator experiments, diagnosis, and subsequent CT scans than the control group ( χ2=33.563, 41.425, 24.842, 17.363, all P<0.05).There were significant higher proportions of high-risk individuals and patients identified through screening in the study group than those in the control group ( χ2=44.880, all P<0.05). The study group had significantly higher positive rates of questionnaire-based initial screening, pulmonary function tests, bronchodilator experiments, and CT scans than the control group ( χ2=29.191, 11.313, 12.370, 4.429, all P<0.05). The overall costs of the screening in the control and study groups were 36 100 and 53 900 yuan, respectively. The cost of pulmonary function tests in the screening for the control and study groups was 1.44 million and 2.45 million yuan, respectively, accounting for 43.19% of the total cost, which was the highest proportion among all costs. The per capita cost for identifying one high-risk individual or patient with COPD was 358.46 Yuan, and the cost in study groups was significantly lower than that in the control group (322.75 vs. 429.45 yuan, χ2=20.396, P<0.05). The per capita net benefits and cost-benefit ratios for the overall subjects in the two groups were 0.37 million yuan and 43.50, respectively. The average net benefit of the study group and the control group was 0.49 million yuan and 0.26 million yuan respectively. The average net benefit of the study group was 0.23 million yuan higher than that of the control group. The cost-benefit ratio of the study group and the control group were 46.77 and 38.61, respectively. The cost-benefit ratio of the study group was 8.16 higher than that of the control group. Conclusion:The screening and intervention for COPD based on family doctor contract services have significant effectiveness, with a marked improvement in screening compliance and high cost-effectiveness, and can be used in community medical institutions with relatively sound family doctor and medical consortium services for targeted COPD screening.