基于社区慢性乙型肝炎抗病毒治疗策略成本效果分析  

Cost-effectiveness of community-based treatment of chronic hepatitis Bin China

作　　者：张顺祥[1] 杨品超 蔡亚丽[1] 林莹[1,2] 邹宇华[2] 

机构地区：[1]深圳市疾病预防控制中心,518055 [2]广东药科大学,广州510006

出　　处：《中华流行病学杂志》2017年第7期860-867,共8页Chinese Journal of Epidemiology

基　　金：深圳市国家科技重大专项配套项目（GJHS20120628150832769）;国家科技重大专项（2008ZX10002-001）

摘　　要：目的我国消除乙型肝炎（乙肝）将会承受巨量的公共卫生资源，基于社区慢性乙肝（chronic hepatitis B，CHB）抗病毒治疗策略的经济学问题凸显，本研究对该策略的成本效果和可支付性做出评价。方法以WHO有关规划和我国重大传染病社区综合防治方案为策略依据，按照我国CHB防治指南确定抗病毒药物治疗和监测内容，遵循成本效果分析理论和方法构建决策分析马尔科夫模型，参数主要采用全国调查或Meta分析结果，利用TreeAge Pro 2015软件实现模型构建和运行。以我国20～59岁社区人群为研究对象，分别从全社会和支付者角度计算成本，效果用质量调整生命年（QALYs），策略间比较采用增量成本效果比（ICER）或成本效果比（CER）。通过敏感性分析明确模型中各参数的不确定性，绘制成本效果可支付曲线评价策略的可支付性。结果我国20-59岁社区人群CHB抗病毒治疗策略的ICER为37598．6元／QALYs，低年龄组人群ICER较小，即每多获得一个QALYs需要增加投入但具有成本效果价值，抗病毒治疗应优先在低年龄人群中实施。乙肝疫苗接种策略的ICER为一64000．0元／QALYs，即该策略每多获得一个QALYs可节省成本，最具成本效果价值。人群CHB抗病毒治疗与乙肝疫苗接种策略对比，CER变动在731．8元和1813．3元／QALYs之间，各年龄人群乙肝疫苗接种的CER均低于抗病毒治疗策略，表明乙肝疫苗接种策略的经济学价值高于抗病毒治疗策略。恩替卡韦成本降低可提高抗病毒治疗策略的成本效果价值，当成本降至一半时，抗病毒治疗成为节省费用的策略。概率敏感性分析表明，抗病毒治疗策略的经济学评价结果可靠，该策略的成本效果价值受公众支付意愿的影响不能忽视。可支付分析发现，按照10万人计算，总预算小于0．3亿元，抗病毒治疗策略无法实现；总预算增加到1�Objective Since eliminating hepatitis B in China would need considerable public health resources, the economics problem of the strategy of community-based antiviral treatment for chronic hepatitis B （CHB） has become an important issue. The cost-effectiveness and affordability of the strategy were evaluated in this study. Methods According to the advocacy on eliminating hepatitis B by WHO and the comprehensive protocol of community based prevention of major infectious diseases and the guideline for CHB prevention and treatment in China, the decision analytic Markov model was constructed with the parameters from national surveys or Meta-analysis. A cohort population aged 20-59 years was used as study subjects. The strategy of CHB antiviral treatment was compared with the strategies of hepatitis B vaccination and non-intervention, respectively. The costs and disability-adjusted life years （QALYs） of the strategies were calculated from the societal and payer perspectives. The incremental cost-effectiveness ratio （ICER） and the cost-effectiveness ratio （CER） were calculated for the comparison of the strategies. One-way and probability sensitivity analysis were performed for uncertainty of the results. And the cost-effectiveness and affordability curves were introduced to estimate the budget impact on the strategies. Results In the Chinese aged 20-59 years, the ICER of CHB antiviral treatment was 37 598.6 yuan （RMB） per QALYs and the ICERs were smaller in the low age groups, indicating that the antiviral treatment strategy is cost-effective and low age groups should be the priority population. The ICER of hepatitis B vaccination was -64 000.0 yuan （RMB） per QALYs, indicating that hepatitis B vaccination is cost saving. The CER of CHB antiviral treatment ranged from 731.8 to 1 813.3 yuan （RMB） per QALYs compared with hepatitis B vaccination, and the CER of CHB antiviral treatment was higher than that of hepatitis B vaccination in all age groups, indicating that hepatitis B vaccination would b

关 键 词：慢性乙型肝炎 治疗 预防 乙型肝炎疫苗接种 成本效果分析 可支付性 

分 类 号：R512.62[医药卫生—内科学]