我国农村地区白内障手术对家庭社会经济能力影响的卫生经济学评价研究

Age-related cataract is leading cause of blindness in China and around the world, is also one of a few avoidable blindness diseases. China has been put a lot resource under current health care reform in rural area, yet the cataract surgery rate (CSR) in rural area has been the lowest in the world. Previous studies have shown the cataract is an important risk factor of poverty, and the success of cataract surgery can be strongly associated with the improvement of social-economic ability of household. However, these studies are observable studies based on data outside China, a more scientific impact evaluation approach using RCT with data collected within China is needed. This study use data from Handan Eye Study representative for China's northern rural areas, we design and conduct a RCT with free cataract surgery and community-based educational campaign based on previous findings, and evaluate the causal relationship between cataract surgery and household social-economic abilities, we as well as investigate the most cost-effective interventions. Based on the study results, we offer policy relevance for China’s anti-poverty program during its thirteenth "five-year plan" especially in health-related poverty, as well as China's theoretical and empirical evidence for health equity.

白内障作为我国首要致盲眼病，是少有的可通过手术干预达到治愈的眼病。但在国家医改进一步加大农村地区卫生投入的整体背景下，我国农村地区的白内障手术率仍旧处于世界较低水平。既往研究发现白内障是导致贫困的重要因素，白内障手术的愈后可能同患者家庭社会经济能力的改善密切相关。但是这些研究的结果都是基于国外数据的观察性研究，需要结合中国的数据并利用证据性更强的随机对照试验进行卫生经济学评价。本研究以具有中国北方农村地区代表性的邯郸眼病研究作为数据基础，前期的研究成果发现经济因素和知识观念是影响手术率重要因素。据此，本研究设计提供免费手术和社区健康宣教相结合的干预方案，开展随机对照研究，论证白内障手术对患者及其家庭社会经济能力改善的因果关系，并探索最具成本效果的干预措施。该研究的成果对于我国在“十三五”期间实现“精准扶贫”特别是农村地区的“健康扶贫”有极强的推广价值，同时为探索实现卫生公平性研究提供中国的理论和实证支持。

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