基于马尔可夫模型的注射吸毒人群丙型病毒性肝炎筛查策略的成本效果分析  

Cost-effectiveness of hepatitis C screening strategy among intravenous drug users based on Markov model

作　　者：刘鹏程 徐迪 赵靓 虞接军 李健[1] LIU Pengcheng;XU Di;ZHAO Liang;YU Jiejun;LI Jian(National Center for STD/AIDS Control and Preventic Chinese Center for Disease Control and Prevention,Beijing 102206,China;Shanghai Municipal Center for Dised Control&Prevention,Shanghai 200336,China)

机构地区：[1]中国疾病预防控制中心性病艾滋病预防控制中心,北京102206 [2]上海市疾病预防控制中心,上海200336

出　　处：《中国艾滋病性病》2023年第12期1301-1308,共8页Chinese Journal of Aids & STD

摘　　要：目的对IDUs人群中以不同筛查频率和筛查率的丙型病毒性肝炎(简称丙肝)筛查方案进行成本效果分析。方法本研究以我国15~45岁的IDUs人群为研究对象构建马尔可夫模型,利用TreeAge Pro 2019软件以1年为周期模拟10万名IDUs在10年内不同筛查策略下的疾病进展。以卫生服务体系视角计算成本,以5%的贴现率对成本和效果进行贴现。效果指标采用质量调整寿命年(QALYs),筛查策略间的比较采用成本效果(CER)、增量成本效果比(ICER)和净货币效益(NMB)。通过单因素敏感性分析和概率敏感性分析评估参数和模型的不确定性。结果研究发现提高筛查频率和筛查率在付出更多成本时可获得更多效果。筛查策略的CER为217.41~1346.00元/QALYs,筛查策略比较时ICER在824.61~5268.05(元/QALYs),NMB在19313.94~221946.95(元/人)。提高筛查频率和筛查率均可获得更多效果,以1倍的人均GDP为意愿支付阈值进行评价,提高筛查频率和筛查率符合成本效果原则。单因素敏感性分析结果显示DAAs价格、纤维化F0~F3期的慢性丙肝患者健康管理成本和IDUs人群丙肝发病率对模型结果影响较大。结论在IDUs人群中进行丙肝筛查时提高筛查频率和筛查率有较高成本效果;提高IDUs人群丙肝筛查频率和筛查率,同时采取综合措施降低DAAs价格和IDUs人群发病率更有助于降低丙肝疾病负担。Objective To evaluate the cost-effectiveness of hepatitis C(HCV)screening strategies among intravenous drug users(IDUs)with different screening frequencies and rates.Methods A Markov model was developed with IDUs aged 15-45 years in China as the research subjects.TreeAge Pro 2019 software was used to simulate the disease progression of 10s IDUs under different screening strategies over a 1 year period.Costs were calculated from the perspective of the health service system,and the cost-effectiveness was discounted at a rate of 5%.The effectiveness index was estimated by quality-adjusted life years(QALYs),while the cost-effectiveness ratio(CER),incremental costeffectiveness ratio(ICER),and net monetary benefit(NMB)were used to compare different types of screening strategies.Uncertainty in parameters and models was evaluated using single-factor and probability sensitivity analysis.Results We found that as costs increased,improving the frequency and rate of screening could lead to greater effectiveness.The CER of the screening strategy was 217.41-1346.00 yuan/QALY.When comparing the screening strategies,the ICER was of 824.61-5268.05 yuan/QALY and the NMB was of 19313.94-221946.95 yuan/person.Both the frequency and rate increase could achieve more effectiveness.Taking 1 times GDP per capita as the threshold of willingness-to-pay for evaluation,the screening frequency and screening rate increase were in accordance with the cost-effectiveness principle.The results of the single-factor sensitivity analysis showed that the price of direct-acting antivirals(DAAs),the cost of health care for chronic HCV patients with fibrosis stage of FO-F3,and the incidence of HCV among IDUs had a significant effect on the model results.Conclusions Increasing the frequency and rate of screening for HCV among IDUs has a relatively higher cost-effectiveness.Improving the frequency and rate of HCV screening among IDUs,and implementing comprehensive measures to reduce the price of DAAs and the incidence of IDUs,will aid in reducing the burden

关 键 词：丙型病毒性肝炎 筛查 注射吸毒人群 成本效果分析 

分 类 号：R512.6[医药卫生—内科学]