浙江省预防乙型肝炎母婴传播策略的经济学评价  

Economic evaluation on strategy for preventing mother-to-child transmission of hepatitis B in Zhejiang Province

作　　者：曾雁冰[1] 罗明梁 何寒青[2] 邓璇[2] 谢淑云[2] 方亚[1] Zeng Yanbing;Luo Mingliang;He Hanqing;Deng Xuan;Xie Shuyun;Fang Ya(School of Public Health, Xiamen University, Xiamen 361102, China;Expanded Program Immunization Department of Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China)

机构地区：[1]厦门大学公共卫生学院,361102 [2]浙江省疾病预防控制中心免疫规划所,杭州310051

出　　处：《中华预防医学杂志》2019年第7期706-712,共7页Chinese Journal of Preventive Medicine

基　　金：浙江省乙肝疫苗接种的经济学评价研究(XDHT2017346A);福建省自然科学基金(2017J01133).

摘　　要：目的评估预防乙型肝炎母婴传播策略的成本效益和成本效果。方法采用决策树-马尔科夫模型,以预防乙型肝炎母婴传播为研究策略,常规普种、不接种作为比较策略,以2016年浙江省出生人数为队列人群,以1年为一个周期,设置81个循环周期数,从全社会角度计算成本,效益用避免感染所减少的感染成本表示,效果用获得的质量调整生命年(QALY)表示,计算净现效益(NPV)、效益成本比(BCR)和增量成本效果比(ICER)。通过一维敏感性分析和概率敏感性分析明确参数的不确定性对结果的影响。乙型肝炎相关疾病感染成本和效用值参数来自现场调查结果,通过面对面问卷调查结合住院病案查询获得,包括了金华、嘉兴和台州市的8家县市级医院,共调查了626例门诊和523例住院的乙型肝炎相关疾病病例,将门诊与住院两部分调查结果结合测算年度总的疾病感染成本。结果预防乙型肝炎母婴传播策略的人均NPV和BCR分别为38 323.78元人民币和21.10,均高于普种策略的36 357.80元人民币和13.58。与常规普种策略相比,预防乙型肝炎母婴传播策略每增加1个QALY,人均可节省费用22 787.07元人民币。一维敏感性分析显示,对BCR和ICER影响最大的参数分别为乙型肝炎疫苗接种率和乙型肝炎相关疾病感染成本;概率敏感性分析表明预防乙型肝炎母婴传播策略获得更多QALY的同时节省了更多的成本。结论预防乙型肝炎母婴传播策略具有高成本效益和成本效果,乙型肝炎疫苗的高接种率是其高经济学价值的关键因素。Objective To evaluate the cost-benefit and cost-effectiveness of current strategy for preventing mother-to-child transmission (PMTCT) of hepatitis B virus. Methods A decision tree model with the Markov process was developed and simulated over the lifetime of a birth cohort in Zhejiang Province in 2016. The current PMTCT strategy was compared with universal vaccination and non-vaccination. Costs were assessed from social perspective. Benefits were the savings from reduced costs associated with disease and effectiveness were measured by quality-adjusted of life-years (QALY) gained. The net present value (NPV), cost-benefit ratio (BCR) and incremental cost-effectiveness ratio (ICER) were calculated. Univariate and Probabilistic Sensitivity Analyses (PSA) were performed to assess parameter uncertainties. The parameters of costs and utilities value of hepatitis B-related disease came from the results of the field survey, which were obtained by face-to-face questionnaire survey combined with inpatient medical records, including eight county and municipal hospitals in Jinhua, Jiaxing and Taizhou. A total of 626 outpatients and 523 inpatient patients were investigated. The annual total costs of infection was calculated by combining the costs of outpatient and inpatient. Results The PMTCT strategy showed a net-gain as 38 323.78 CNY per person, with BCR as 21.10, which was higher than 36 357.80 CNY per person and 13.58 respectively of universal vaccination. Compared with universal vaccination, the PMTCT strategy would save 2 787.07 CNY per additional QALY gained for every person, indicating that PMTCT would be cost-saving. The most important parameters that could affect BCR and ICER were the vaccine coverage rate and costs of hepatitis B related diseases respectively. The PSA showed the PMTCT strategy was preferable as it would gain more QALY and save costs. Conclusions The PMTCT strategy appeared as highly cost-beneficial and highly cost-effective. High vaccination rate was a key factor of high economic value.

关 键 词：肝炎 乙型 成本及成本分析 母婴传播 效益和效果 马尔科夫模型 

分 类 号：R512.62[医药卫生—内科学] R186[医药卫生—临床医学]