2015—2022年西藏棘球蚴病人群筛查和患者治疗成本效果分析  

Cost‑effectiveness analysis of population screening and patient treatment for echinococcosis in Xizang from 2015 to 2022

作　　者：雷家希 贡桑曲珍[2] 王立英 杨频 程茜茜 王芝依 姜明哲 LEI Jiaxi;GONGSANG Quzhen;WANG Liying;YANG Pin;CHENG Xixi;WANG Zhiyi;JIANG Mingzhe(National Institute of Parasitic Diseases,Chinese Center for Disease Control and Prevention,Chinese Center for Tropical Diseases Research,National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases,Key Laboratory on Parasite and Vector Biology,National Health Commission,WHO Collaborating Centre for Tropical Diseases,National Center for International Research on Tropical Diseases,Ministry of Science and Technology,Shanghai 200025,China;Xizang Center for Disease Control and Prevention,NHC Key Laboratory of Echinococcosis Prevention and Control,Lhasa 850000,Xizang,China)

机构地区：[1]中国疾病预防控制中心寄生虫病预防控制所(国家热带病研究中心),传染病溯源预警与智能决策全国重点实验室,国家卫生健康委员会寄生虫病原与媒介生物学重点实验室,世界卫生组织热带病合作中心,科技部国家级热带病国际联合研究中心,上海200025 [2]西藏自治区疾病预防控制中心,国家卫生健康委包虫病防治研究重点实验室,西藏拉萨850000

出　　处：《中国寄生虫学与寄生虫病杂志》2025年第1期44-51,60,共9页Chinese Journal of Parasitology and Parasitic Diseases

基　　金：国家卫生健康委包虫病防治研究重点实验室开放课题(2024WZK1001);中国疾病预防控制中心寄生虫病预防控制所科技创新支撑计划(TF2024005)。

摘　　要：目的分析2015—2022年西藏棘球蚴病人群筛查和患者治疗的成本-效果,为制定或调整棘球蚴病防治策略和措施提供参考。方法从西藏自治区包虫病防治工作年报系统收集2015—2022年西藏棘球蚴病人群筛查和患者治疗方面投入的成本、查出新患者数、治疗效果等相关数据。计算各年度、各地区/市的筛查和治疗的成本-效果。用增量成本-效果比(ICER)反映西藏棘球蚴病实际发生的伤残调整寿命年(DALY)与无干预下估算的DALY之间的差异△E与查治成本△C之间的关系。ICER与人均国内生产总值(GDP)的比值作为支付意愿阈值(WTP)。不同年份之间治疗总有效率的差异用K-W检验,使用Bonferroni法进行两两比较,并校正P值。结果2015—2022年西藏在棘球蚴病人群筛查经费投入总成本为5417.1万元,2017年最高(2762.4万元)。2017—2022年新发现患者的筛查成本-效果比呈逐年增高趋势,由2017年的1641元/人升高到2022年的21131元/人。2022年,日喀则市筛查新发现患者率最高(0.10%),山南市最低(0.00%),相应的筛查成本-效果比分别为1.0万元/人和20.9万元/人。2015—2022年西藏患者治疗投入总成本为8056.0万元,2018年度最高(3905.5万元)。其中手术治疗成本占比73.0%(5880.7万元),药物治疗成本占比27.0%(2175.4万元)。西藏2015—2022年患者总治愈率为11.1%,治愈率年度变化趋势不明显,好转率呈上升趋势,在2022年达到了68.6%。西藏自治区实际DALY低于无干预情况下的DALY,挽回的DALY损失由2017年的6293.03增加到了2022年的11487.84。2017—2022年西藏棘球蚴病人群筛查及患者治疗ICER平均为11460.3元/年,WTP为0.196。结论西藏2017—2022年棘球蚴病的人群筛查和患者治疗方面投入较大,资金利用效率较高。通过普查,发现了大量处于早期的棘球蚴病患者,并积极安排了手术救治和药物治疗。但目前筛查效率较低的地区已不再适合大规模人群筛Objective To analyze the cost-effectiveness of population screening and patient treatment for echi-nococcosis in Xizang from 2015 to 2022,so as to provide insights into formulation or adjustment of the echinococcosis control strategies and measures.Methods The costs for population echinococcosis screening and echinococcosis patient treatment,newly diagnosed echinococcosis cases,and treatment efficiency in Xizang from 2015 to 2022 were collected from the annual report system of the Hydatid Disease Prevention and Control Program in Xizang Autonomous Region,and the cost-effectiveness of echinococcosis screening and treatment was calculated in each year from 2015 to 2022 and in each prefecture/city.The incremental cost-effectiveness atio(ICER)was used to examine the association of the differ-ence(△E)between the actual disability-adjusted life years(DALYs)due to echinococcosis and the estimated DALYs without interventions with the total costs of echinococcosis screening and treatment(△C)in Xizang,and the willingness-to-pay(WTP)threshold was measured as a ratio of ICER to per capita gross domestic product(GDP).The difference in the overall response to treatment was tested for statistical significance with Kruskal-Wallis(K-W)test among years,fol-lowed by pairwise comparisons with Bonferroni corrections.Results The total costs of population screening for echino-coccosis were 54.171 million yuan in Xizang from 2015 to 2022,with the highest in 2017(27.624 million yuan).The cost-effectiveness ratio for screening newly detected echinococcosis cases appeared a tendency towards a rise over years from 2017 to 2022,from 1641 yuan/person in 2017 to 21131 yuan/person in 2022.The proportion of newly detected echinococcosis cases by screening was highest in Shigatse City(0.10%)and lowest in Shannan City(0.00%)in 2022,and the cost-effectiveness ratios were 10000 yuan/person and 209000 yuan/person,respectively.The total costs for echi-nococcosis patient treatment were 80.560 million yuan in Xizang from 2015 to 2022,peaking in 2018

关 键 词：棘球蚴病 成本‑效果分析 人群筛查 患者治疗 西藏 

分 类 号：R532.32[医药卫生—内科学]