广东省梅毒综合防治示范区梅毒干预策略的卫生经济学评价  

Health economics evaluation of syphilis intervention strategy in syphilis integrated prevention and control area of Guangdong Province

作　　者：邹亚明[1] 刘凤英[2] 陈磊[2] 沈鸿程 黄澍杰[2] 郑和平[2] 杨斌[2] 郝元涛[3] ZOU Ya-ming LIU Feng-ying CHEN Lei SHEN Hong-cheng HUANG Shu-jie ZHENG He-ping YANG Bin HAO Yuan-tao(Department of Public Health, Wuxi Center for Disease Control and Preven- tion, Wuxi 214023, China Department of Sexually Transmitted Infections Control, Dermatology Hospital of Southern Medical University, Guangzhou 510091, China Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China)

机构地区：[1]无锡市疾病预防控制中心公共卫生部,江苏无锡214023 [2]南方医科大学皮肤病医院性病控制科,广东广州510091 [3]中山大学公共卫生学院医学统计与流行病学系,广东广州510080

出　　处：《中华疾病控制杂志》2017年第4期409-413,427,共6页Chinese Journal of Disease Control & Prevention

基　　金：广东省医学科研基金(C2016021)

摘　　要：目的对广东省梅毒综合防治示范区梅毒干预策略进行卫生经济学评价,为优化和制定梅毒防控策略提供科学依据。方法考虑两种梅毒干预策略:80%梅毒筛查覆盖率(策略1)和85%梅毒筛查覆盖率(策略2)。通过示范区现场调查和文献查阅获得相关参数,建立梅毒筛查的Markov模型,模拟1万名梅毒高危人群分别在两种策略下20年的社会总成本和期望健康结局,进行成本效果分析和敏感性分析。结果策略2相比于策略1,增加成本3 998.88万元,但能够避免28例一期梅毒、34例二期梅毒、337例潜伏期梅毒以及8例三期梅毒病例的发生,挽救392伤残调整寿命年(disability adjusted life years,DALYs),增量成本效果比为10.195万元/DALYs。敏感性分析提示,当梅毒发病率和晚期梅毒进展到三期梅毒概率越高,二期梅毒和晚期潜伏梅毒的治疗率越低时,梅毒筛查会具有更多的成本效果。结论示范区采取的梅毒干预策略具有成本效果,该项目具有可推广性。Objective To evaluate the intervention strategies in Guangdong initiative for comprehensive control of syphilis （GICCS） frown the aspect of health economics,and to provide the scientific basis for optimization and formulation of syphilis prevention and control strategy.Methods Two kinds of syphilis intervention strategies were considered：one was 80 percent coverage of syphilis screening （Strategy 1） and the other was 85 percent coverage of syphilis screening （Strategy 2）.A Markov model for syphilis screening was applied based on the results of field surveys in GICCS and published literature.Cost-effectiveness analysis and sensitivity analysis were conducted through simulating the total costs and expected health outcomes of 10 000 syphilis high-risk people during the time horizon of 20 years under strategy 1 and Strategy 2 respectively from the societal perspective.Results Compared to strategy 1,strategy 2 would cost 3 998.88 million yuan more but avert 28 primary syphilis,34 secondary syphilis,337 latent syphilis and 8 tertiary syphilis cases and 392 disability adjusted life years （DALYs） at the same time.The incremental cost effectiveness ratio was 101.95 thousand yuan per DALYs.Sensitivity analyses showed that syphilis screening programme would have more cost effectiveness when the incidence of syphilis and the probability of late latent syphilis progressing to tertiary syphilis increased and the treatment rates of secondary syphilis and late latent syphilis decreased.Conclusion The syphilis intervention strategies GICCS adopts have cost effectiveness and can be popularized.

关 键 词：梅毒 成本及成本分析 评价研究 MARKOV链 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]