文章摘要
石果,张顺祥.乙型肝炎病毒母婴传播阻断策略的决策分析及成本效益评价[J].中华流行病学杂志,2013,34(3):273-278
乙型肝炎病毒母婴传播阻断策略的决策分析及成本效益评价
Decision tree and cost.benefit analysis on strategies related to preventing maternal-infantile transmission of hepatitis B virills tnfection
投稿时间:2012-12-03  
DOI:
中文关键词: 乙型病毒性肝炎;母婴传播;疫苗免疫;成本效益分析;决策分析;马尔科夫模型
英文关键词: Hepatitis B virus;Matemal—infantile transmission;Vaccination;Cost—benefit analysis;Decision analysis;MarkOV model
基金项目:国家“十一五”科技重大专项(2008ZXl0002—001)
作者单位E-mail
石果 450001 郑州大学公共卫生学院  
张顺祥 深圳市疾病预防控制中心 zhangsx@szcdc.net 
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中文摘要:
      目的 综合各种HBV母婴传播阻断的影响因素,评价母婴传播阻断方案成本效益并明确其优选方案.方法 构建符合中国实际的HBV母婴传播阻断策略决策树马尔科夫模型(其中参数依据Meta分析、现场调查和文献查阅等方法确定);HBV母婴传播阻断方案的优化指标包括总成本、总效益、净效益值及效益成本比(BCR),并对模型中的参数对优化方案的影响进行敏感性分析.结果 针对中国现阶段6种可能的HBV母婴传播阻断方案,构建了多级决策树模型;分别考虑了HBsAg和HBeAg筛检、不同剂量(次)乙型肝炎(乙肝)疫苗和免疫球蛋白(HBIG)的选用情况.6种方案的BCR均大于1,可获得的效益均超过成本至少4倍.各方案中以孕妇筛查HBsAg,HBsAg阳性新生儿接种10 μg×3乙肝疫苗加一剂100 IU HBIG,HBsAg阴性新生儿接种10 μg×3乙肝疫苗的方案最优.HBV母婴传播阻断方案中,采用100 IU或200 IU的HBIG,其BCR相近;采用l剂次HBIG(100 IU或200 IU)其BCR均高于2剂次.敏感性分析显示,参数对优化方案的影响大小依次为接种率、母婴传播阻断率、HBsAg阳性率、乙肝相关疾病经济负担、贴现率、接种费和筛检费,其中接种率和阻断率为HBV母婴传播阻断优化方案中最重要的影响因素.结论 孕妇筛检HBsAg,新生儿采用10 μg乙肝疫苗联合100 IU的HBIG是HBV母婴传播阻断的最优方案;方案中的接种率和阻断效率,是确保HBV母婴传播阻断的关键.
英文摘要:
      Objective To investigate the economic burden of patients with acute and chronic hepatitis B,cirrhosis and liver cancer caused by hepatitis B virus (HBV).Methods Cluster sampling was used on cases consecutively collected during the study period.Questionnaire survey was conducted and information on the expenses during hospitalization was collected from the hospital records and through interviewing those patients.Results Yearly costs related to patients with acute hepatitis B,severe hepatitis B,chronic hepatitis B,cirrhosis,hepatocellular carcinoma were 66.7,138.1,127.4,151.7 and 377.2 thousand Yuan,respectively.Results from multiple linear regression model showed that the type of medical insurance scheme,annual days of hospitalization,classifications of HBV-related diseases and personal income were major influencing factors on the cost.Conclusion HBV infection caused considerable burden to families and the society,indicating that HBV infection control programs would bring huge potential benefits.The reform of insurance scheme should be administrated to promote social fairness.
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