全国结核病免费医疗策略实施的效果和影响预测  

Prediction of the effectiveness and impact of the free healthcare policy for tuberculosis in China

作　　者：周文雍 文泽轩 高梦贤 李涛[3] 张慧[3] 王伟炳[1,2] Zhou Wenyong;Wen Zexuan;Gao Mengxian;Li Tao;Zhang Hui;Wang Weibing(Shanghai Institute of Infectious Disease and Biosecurity,Fudan University,Shanghai 200032,China;Department of Epidemiology,Key Laboratory of Public Health Safety of Ministry of Education,School of Public Health,Fudan University,Shanghai 200032,China;National Center for Tuberculosis Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 102206,China)

机构地区：[1]复旦大学上海市重大传染病和生物安全研究院,上海200032 [2]复旦大学公共卫生学院流行病学教研室/公共卫生安全教育部重点实验室,上海200032 [3]中国疾病预防控制中心结核病预防控制中心,北京102206

出　　处：《中国防痨杂志》2023年第9期845-856,共12页Chinese Journal of Antituberculosis

基　　金：加强重大传染病防控政策倡导项目(INV-035022)。

摘　　要：目的:对我国的结核病免费医疗政策实施对结核病疫情和经济的近远期影响进行预测,为在我国实行结核病免费医疗的必要性和可行性提供科学依据。方法:基于结核病自然史等搭建结核病传播动力学模型,并分别在假设年发病例数递降率维持不变及假设在其他干预措施的影响下,年发病例数递降率逐渐增大的两个模拟场景下,预测结核病免费医疗方案实施对我国结核病疫情变化趋势的影响,并采用成本-效果、成本-效用和成本-效益等常用卫生经济学方法评估结核病免费医疗政策的经费投入所产生的社会效益。结果:递降率维持现有水平时,到2035年可累计减少7 584 954例结核分枝杆菌潜伏感染(latent tuberculosis infection, LTBI)者和390 333例结核病发病患者,可累计增加195 486例成功治疗的敏感结核病患者和62 251例耐药结核病患者,能够挽回2 448 501伤残调整生命年(disability adjusted life year, DALY)和27 328 042万元的社会经济价值,政府每额外投入1元可挽回社会经济价值11.24元;年发病率递降速率增大时,到2035年可累计减少5 730 438例LTBI和273 441例结核病发病患者,可累计增加179 592例成功治疗的敏感结核病患者和49 835例耐药结核病患者,能够挽回2 179 554 DALY和23 310 346万元的社会经济价值,政府每额外投入1元可挽回社会经济价值12.58元。结论:免费医疗方案的实施能明显减少结核病的传播,对于挽回社会经济价值的效果十分显著,而这些效果在年发病例数递降率增大的情景下更佳,建议政府尽早实施结核病免费医疗方案,并实施其他干预措施控制结核病的传播。Objective:This study predicted the short-term and long-term epidemiological and economic impacts of the implementation of free tuberculosis(TB)healthcare policy in China,providing scientific evidence for the necessity and feasibility of free TB healthcare policy in China.Methods:Based on the natural history of TB,a TB dynamic model was developed,and two simulation scenarios were simulated to predict the impact of implementing free TB healthcare policy on the trend of TB epidemic,assuming a constant decline rate of annual incidence of TB and a gradually increasing decline rate of annual incidence of TB under other interventions,respectively.The cost-effectiveness,cost-utility,and cost-benefit analyses were conducted to evaluate the social benefits of the government’s investment on free TB healthcare policy.Results:With the free TB health care policy,when the decline rate is maintained at the current level,by 2035,7584954 latent TB infections(LTBI)and 390333 TB cases can be avoided cumulatively,195486 successfully treated drug-sensitive TB patients and 62251 drug-resistant TB patients can be increased cumulatively,and 2448501 disability-adjusted life years(DALY)and a social economic value of 273280420000 yuan can be saved.Every extra yuan invested by the government can generate a social economic value of 11.24 yuan.When the decline rate increases,by 2035,5730438 LTBI and 273441 TB cases can be avoided cumulatively,179592 successfully treated drug-sensitive TB patients and 49835 drug-resistant TB patients can be increased cumulatively,and 2179554 DALY and a social economic value of 233103460000 yuan can be saved.Every extra yuan invested by the government can generate a social economic value of 12.58 yuan.Conclusion:Implementing free TB healthcare policy can significantly reduce the transmission of TB and has a significant effect on saving social economic cost.These effects are more significant when the annual incidence of TB declines faster.It is recommended that the government shall implement free TB healthcare

关 键 词：结核 传染病控制 免费医疗 模型 统计学 预测 

分 类 号：R181.25[医药卫生—流行病学]