甘肃省≥15岁人群接种乙型脑炎减毒活疫苗的成本效用分析  

Cost-utility analysis of Japanese encephalitis vaccination among individuals≥15 years of age in Gansu province

作　　者：付思成 郭小熙 贵春燕 焦新宇 王旭霞[2] Fu Sicheng;Guo Xiaoxi;Gui Chunyan;Jiao Xinyu;Wang Xuxia(School of Public Health,Gansu University of Traditional Chinese Medicine,Lanzhou 730000,Gansu,China;Gansu Provincial Center for Disease Control and Prevention,Lanzhou 730000,Gansu,China;School of Economics and Management,Chinese University of Hong Kong,Shenzhen 518172,Guangdong,China;School of Public Health,Lanzhou University,Lanzhou 730000,Gansu,China)

机构地区：[1]甘肃中医药大学公共卫生学院,甘肃兰州730000 [2]甘肃省疾病预防控制中心,甘肃兰州730000 [3]香港中文大学(深圳)经济管理学院,广东深圳518172 [4]兰州大学公共卫生学院,甘肃兰州730000

出　　处：《中国疫苗和免疫》2024年第4期485-491,共7页Chinese Journal of Vaccines and Immunization

基　　金：国家自然科学基金(82060614)。

摘　　要：目的评估甘肃省≥15岁人群接种乙型脑炎(乙脑)减毒活疫苗(Japanese encephalitis attenuated live vaccine,JEV-L)的成本效用。方法构建甘肃省和三个乙脑高发市(天水市、平凉市和陇南市)≥15岁人群不接种、接种1剂次、接种2剂次JEV-L策略的决策树-Markov模型,计算相应成本和质量调整生命年(Quality-adjusted life year,QALY),以及接种1剂次和2剂次与不接种相比的增量成本效用比(Incremental cost-utility ratio,ICUR)和增量净货币效益(Incremental net monetary benefit,INMB),并进行敏感性分析。结果甘肃省≥15岁人群接种1剂次和2剂次JEV-L与不接种相比,ICUR(元/QALY)分别为30143.9和62569.8,人均INMB分别为3.2元和-16.0元;天水市、平凉市和陇南市相应ICUR(元/QALY)分别为10063.1和25544.2、9404.6和24454.2、4442.5和15456.7,相应人均INMB分别为30.0元和13.2元、31.7元和15.0元、51.4元和36.4元。单因素敏感性分析显示乙脑发病率、贴现率、年龄别自然死亡率、疫苗价格及接种实施费用对ICUR影响较大。结论甘肃省≥15岁人群1剂次JEV-L免疫策略以及乙脑高发市1剂次和2剂次JEV-L免疫策略均具有成本效用。Objective To evaluate the cost-utility of vaccination with Japanese encephalitis attenuated live vaccine(JEV-L)among a population≥15 years of age in Gansu province.Methods We constructed a decision-tree Markov model of non-,one-,and two-dose JEV-L vaccination strategies among≥15-year-olds in Gansu province and three prefectures that had high incidences of Japanese encephalitis to determine costs and quality-adjusted life years(QALYs).We calculated incremental cost-utility ratios(ICURs)and incremental net monetary benefits(INMBs)of one-dose and two-dose vaccination strategies compared with non-vaccination and conducted sensitivity analyses.Results ICURs of one-dose and two-dose JEV-L vaccination strategies among≥15-year-olds in Gansu province were 30143.9 and 62569.8 yuan per QALY compared with non-vaccination,respectively,with INMBs per person being 3.2 and-16.0 yuan.In the three prefectures,corresponding ICURs(yuan per QALY)were 10063.1 and 25544.2;9404.6 and 24454.2;and 4442.5 and 15456.7,with INMBs(yuan)per person being 30.0 and 13.2;31.7 and 15.0;and 51.4 and 36.4.Univariate sensitivity analysis showed that Japanese encephalitis incidence,discount rate,age-specific natural mortality,and vaccine price/vaccination implementation cost were the most important parameters influencing ICURs.Conclusions A one-dose JEV-L vaccination strategy among≥15-year-olds has good cost-utility in Gansu province;both one-dose and two-dose JEV-L vaccination strategies have good cost-utility in prefectures with high incidences of Japanese encephalitis.

关 键 词：流行性乙型脑炎 乙型脑炎减毒活疫苗 预防接种 成本效用分析 决策树-Markov模型 

分 类 号：R186[医药卫生—流行病学] R511.7[医药卫生—公共卫生与预防医学]