北京市结核病传染源管理新模式研究与经济学评价  

A research and economic evaluation on a new model for tuberculosis infection management in Beijing

作　　者：高婷[1] 金承刚[2] 苏宁[1] 于建平[1] 朱瑞[1] 庞星火[1] GAO Ting JIN Cheng-gang SU Ning YU Jian-ping ZHU Rui PANG Xing-huo(Beijing Center for Diseases Control and Prevention, Beijing 100013, China)

机构地区：[1]北京市疾病预防控制中心,100013 [2]北京师范大学

出　　处：《首都公共卫生》2016年第5期193-197,共5页Capital Journal of Public Health

基　　金：北京市科委项目(编号:D121100003012003)

摘　　要：目的比较结核病传染源住院综合治疗与居家隔离治疗效果,利用经济学评价探索最优结核病传染源管理模式,为政府决策提供依据。方法以2012年1月1日-2015年9月30日在北京市朝阳区疾控中心结核门诊登记管理的所有痰涂片阳性的肺结核病例作为研究对象,将其治疗资料录入在线数据库,数据描述和分析采用SPSS 22.0软件;经济学评价采用质量调整生命年和马尔科夫模型进行模拟分析。结果住院治疗仅占涂阳病例的21.25%;住院组病例采用个体化方案治疗的比例高于居家隔离治疗组(χ2=47.07,P<0.001)。住院和居家治疗初治病人痰涂片转阴率差异无统计学意义(HR=1.025,P=0.831),而住院治疗复治的患者则差异有统计学意义,住院治疗转阴率是居家隔离的8倍(HR=8.079,P=0.037)。当政府支付意愿<11 281元/QALY时,则采取传统的模式(88%居家+12%住院);当政府支付意愿值提高到11 281元/QALY时,则应开展80%居家隔离+20%住院模式;政府的支付意愿应增加到157 129元/QALY时,才能采用全住院模式。结论畅通的双向转诊机制下的20%住院和80%居家强制隔离治疗的新传染源管理新模式符合国情,为结核病的控制提供了科学决策依据。Objective To compare the effect on tuberculosis （TB） infection using comprehensive treatment in hospitals and isolated home treatment, to explore the optimal TB infection management mode using economic evaluation, and to provide reference for government decision-making. Methods During January 1, 2012 and September 30, 2015, all the sputum smearpositive pulmonary tuberculosis cases were recruited under research in Chaoyang CDC TB clinics. Their treatment records were input into an online database. SPSS 22.0 were used for descriptive and analytic statistics. Quality-adjusted life years （QALY） and Markov model were used for economic evaluation. Results Only 21.25% of smear-positive cases were hospitalized; and proportion of individualized treatment was higher in hospitalized group than in home treatment group （x^2 = 47.07, P 〈 0. 001 ）. The sputum conversion rate showed no significant difference between the hospitalized group and the home treatment group in early treatment （ HR = 1. 025, P = 0. 831 ）. And in recurrent hospitalization, the sputum conversion rate between the two groups showed significant difference, the hospitalized group was eight times higher than the home treatment group （ HR = 8. 079, P = 0.037）. When the government willingness-to-pay （WTP） reached 11 281 yuan/QALY, the traditional model （88% home treatment ＋ 12% hospitalization） should be taken; and when the government WTP increased to 11 281 yuan/QALY, the model that 80% home treatment ＋ 20% hospitalization should be carried out. Only when the government WTP increased to 157 129 yuan/QALY could whole hospitalization model be implemented. Conclusion With a fine bidirectional referral system, a new infection source management medel that 20% hospitalization and 80% home treatment is in line with our national condition. And thisnew management model provides scientific decision basis for TB control.

关 键 词：结核病 传染源 管理新模式 经济学评价 

分 类 号：R52[医药卫生—内科学]