2013年“乙型肝炎疫苗事件”经济学损失评价  

Evaluation of economic outcomes of ＂hepatitis B vaccine event reported by media＂ in China, 2013

作　　者：张顺祥[1] 孙盼盼[1] 夏云 Zhang Shunxiang;Sun Panpan;Xia Yun(Institute of Communicabal Disease Control and Prevention,Shenzhen Center for Disease Control and Prevention,Shenzhen 518055,China)

机构地区：[1]深圳市疾病预防控制中心传染病预防控制所,518055 [2]广东药学院公共卫生学院

出　　处：《中华预防医学杂志》2018年第8期837-841,共5页Chinese Journal of Preventive Medicine

基　　金：深圳市国家科技重大专项配套基金（GJHS20120628150832769）

摘　　要：目的 探讨因发生＂乙型肝炎疫苗（HepB）事件＂导致全国及深圳市增加的投入、损失的经济效益和效果。方法 采用决策分析Markov模型，分别以2013年我国出生人口数为研究队列，以HepB接种率和乙型肝炎表面抗体（抗-HBs）阳转率为相关参数；从医疗卫生和社会角度分别计算和比较事件发生与否导致的人均成本、效益和效果，其中效果指标包括乙型肝炎病毒（HBV）感染和乙型肝炎相关疾病数、人均质量调整生命年（QALY）；成本效益和成本效果分析指标包括效益成本比（BCR）和总成本与净效果之比（元/QALY）。结果 从医疗卫生和社会角度看，与未发生＂乙型肝炎疫苗事件＂相比，发生该事件使全国HepB接种者的人均成本分别增加了6 796.60和8 451.45元，而人均效益分别减少了6 799.57和8 484.41元；BCR分别由9.10和8.58减低为2.48和2.43。而深圳市HepB接种对象人均成本分别增加了5 244.88和8 937.64元，而人均效益分别减少了5 248.11和8 977.27元；BCR分别由16.21和14.54减低为3.11和3.04。发生＂乙型肝炎疫苗事件＂，使全国和深圳市HBV感染例数分别增加了213.14万和1.81万例，以急性乙型肝炎和慢性乙型肝炎增加例数最多，全国分别增加了19.03万和8.07万例，深圳市分别增加了794和395例；而全国和深圳市总成本与净效果之比分别减少了0.12和0.09元/QALY；从医疗卫生角度，每获得1个QALY需要的成本，由6 231.90和3 567.25元分别升高到了22 883.51和18 571.49元；从社会角度，由8 252.79和6 807.45元分别升高到29 091.92和32 553.60元。结论 ＂乙型肝炎疫苗事件＂造成了乙型肝炎免疫预防成本的增加和效益的减少，经济学价值降低。Objective To edentify the increased cost, the decreased benefits and effectiveness of hepatitis B vaccine event reported by media in 2013 in China both in Chinese nationwide and in Shenzhen.Methods The decision analytic-Markov models were constructed. The cohort born in 2013 in nationwide and in Shenzhen were respectively introduced to the models. The vaccination coverage and the rates of antibody to hepatitis B surface antigen were determined as major parameters. The average costs and benefits per case, the effectiveness which included the numbers of hepatitis B virus （HBV） infection and the patients with HBV-related diseases, the average quality-adjusted life years （QALYs） per case were calculated from the medical-care and societal perspectives. The benefit cost ratio （BCR）, ratio of the total costs and the net QALYs were as indicators of cost-benefit and cost-effectiveness analysis, respictively.Results In nationwide, the BCRs decreased from 9.10 and 8.58 to 2.48 and 2.43, respectively, because the average costs increased to 6 796.60 yuan （RMB） and 8 451.45 yuan, and average benefits decreased to 6 799.57 yuan and 8 484.41 yuan, respectively, from the medical-care and societal perspectives. In Shenzhen, the BCRs decreased from 16.21 and 14.51 to 3.11 and 3.04 with the average costs of 5 244.88 yuan and 8 937.64 yuan, and average benefits of 5 248.11 yuan and 8 977.27 yuan. Totally, the increase of 2.1314 million and 181 hundreds of the HBV infectors occurred for the event in nationwide and in Shenzhen, respectively. Of all the infectors increased the most, the numbers of acute and chronic hepatitis B were 1 904 hundreds and 807 hundreds in nationwide, 794 and 395 in Shenzhen, espectively. The decreases of average QALY per case were 0.119 8 in nationwide and 0.090 6 in Shenzhen. The costs per averted a QALY increased from 6 231.90 yuan to 22 883.51 yuan in nationwide, from 3 567.25 yuan to 1 8571.49 yuan in Shenzhen （for medical-care perspective）, from 8 252.79 yuan and 6 807.45 yuan to 2

关 键 词：肝炎 乙型 疫苗 接种 成本效果分析 成本效益分析 

分 类 号：R186[医药卫生—流行病学]