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국민건강보험공단의 건강검진서비스는 우리나라에서 시행되고 있는 규모가 가장 큰 건강검진 프로그램임에도 불구하고, 그 동안 비용-효과에 대한 연구는 거의 이루어지지 않았다. 본 연구에서는국민건강보험공단의 건강검진 프로그램의 한 부분인 제2형 당뇨 건강검진을 대상으로 비용-효과분석을 실시하였다. 이를 위해 당뇨 건강검진을 받은 검진군과 받지 않은 비검진군에 대한 가상코호트를 각각 설정하였다. 1996년에 건강검진을 받은 참가자들 중에서 선정된 가상코호트에서 사망 또는 100세까지 당뇨병과 합병증의 발생을 예측하기 위해서 제2형 당뇨병의 자연적 과정을 반영한 마르코프 과정(Markov Process) 모형을 사용하였다. 연구의 주요결과는 다음과 같다. 첫째, 1회 당뇨 건강검진은 우리나라 전체 인구특성을 고려하였을 때, 당뇨 환자 1인당 0.76년의 생존기간 연장(LYG), 0.23년의 질보정생존년수(QALY) 연장 효과를 각각 기대할 수 있었다. 둘째, 당뇨건강검진은 환자 1인당 보험자 관점에서 약 37만 원, 사회적 관점에서 약 72만 원의 비용을 절감시킨다. 따라서 현재 시행 중인 공단의 당뇨 건강검진사업은 효과를 향상시키면서 동시에 비용도 절감시키는 우월적 대안이다. 셋째, 1QALY 연장을 기준으로 보험자 관점에서 약 162만 원을, 사회적 관점에서는 약 313만 원의 절감효과를 기대할 수 있었다. 장차, 인구의 노령화와 식습관 및 생활습관의 변화 등으로 당뇨 유병인구가 더욱 증가할 가능성이 높음을 고려해볼 때, 당뇨 건강검진의 중요성은 더욱 더 증대될 것으로 판단된다.


While health screening service of the National Health Insurance Corporation (NHIC) is the largest health screening program in South Korea, its fectiveness has not been examined. The present study, therefore, conducted cost-effective analysis of Type 2 Diabetes Mellitus(DM) screening that is a part of NHIC health screening program. Of simulated cohort selected among all health screening participants in 1996, a Markov process model that reflects natural course of Type 2 DM was used to predict the occurrence of DM and its complications until death or 100 years of age. The distribution of DM and its Complications that was initial input data for Markov process model was extracted from individual 10-year cohort data from NHIC database. The results show that the Type 2 DM screening group compared to non- DM screening group increased 0.76 life year gained (LYG) and 0.23 quality-adjusted life years (QALY) per person and reduced 370,000 won per person from the insurer's perspective and 7,200,000 won per person from the societal perspective for asymptomatic diabetic patient. This total medical cost reduction is attributable to the reduced direct and indirect medical treatment costs for less complications of DM by early detection. The incremental cost effectiveness ratio was -3,132,215won/QALY and -943,316won/LYG. The results of the present study proved that NHIC DM Screening is effective in extending the quality of life as well as reducing medical cost.


While health screening service of the National Health Insurance Corporation (NHIC) is the largest health screening program in South Korea, its fectiveness has not been examined. The present study, therefore, conducted cost-effective analysis of Type 2 Diabetes Mellitus(DM) screening that is a part of NHIC health screening program. Of simulated cohort selected among all health screening participants in 1996, a Markov process model that reflects natural course of Type 2 DM was used to predict the occurrence of DM and its complications until death or 100 years of age. The distribution of DM and its Complications that was initial input data for Markov process model was extracted from individual 10-year cohort data from NHIC database. The results show that the Type 2 DM screening group compared to non- DM screening group increased 0.76 life year gained (LYG) and 0.23 quality-adjusted life years (QALY) per person and reduced 370,000 won per person from the insurer's perspective and 7,200,000 won per person from the societal perspective for asymptomatic diabetic patient. This total medical cost reduction is attributable to the reduced direct and indirect medical treatment costs for less complications of DM by early detection. The incremental cost effectiveness ratio was -3,132,215won/QALY and -943,316won/LYG. The results of the present study proved that NHIC DM Screening is effective in extending the quality of life as well as reducing medical cost.