| 陈振明,纪双斌,史湘铃,赵跃媛,张雪峰,金辉.Markov决策树模型在优化15~49岁女性戊型肝炎免疫接种策略中的应用[J].中华流行病学杂志,2017,38(2):267-271 |
| Markov决策树模型在优化15~49岁女性戊型肝炎免疫接种策略中的应用 |
| Use the Markov-decision tree model to optimize vaccination strategies of hepatitis E among women aged 15 to 49 |
| 收稿日期:2016-11-01 出版日期:2017-02-17 |
| DOI：10.3760/cma.j.issn.0254-6450.2017.02.026 |
| 中文关键词: 戊型肝炎 女性 免疫接种策略 |
| 英文关键词: Hepatitis E Femininity Vaccination strategies |
| 基金项目:国家自然科学基金（81573258）；江苏省大学生课外研学训练计划（S2015135）；江苏省重大新发传染病综合防控科技示范工程（BE2015714） |
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| 中文摘要: |
| 目的 比较15~49岁女性人群戊型肝炎（戊肝）疫苗不同免疫接种策略的成本和效用，从而为戊肝免疫接种策略的制定和优化提供科学依据。方法 应用Markov决策树模型，评价15~49岁女性人群戊肝疫苗接种策略：100%接种策略、筛查后易感人群接种策略和不接种策略，评价指标为增量成本效用比，并进行敏感性和阈值分析。结果 从社会角度看，同不接种策略相比，筛查后接种策略和100%接种策略，人均分别增加0.10个健康生命年，增量成本效用比为5 651.89元/质量调整生命年和6 385.33元/质量调整生命年。敏感性分析和阈值分析显示，当疫苗价格均<191.56元时，100%接种策略优于筛查后接种策略；当疫苗价格均>191.56元时，筛查后接种策略优于100%接种策略。接种依从率均<23%时，100%接种策略优于筛查后接种策略；依从率均>23%时，筛查后接种策略优于100%接种策略。随着易感者年感染率的增加，筛查后接种策略和100%接种策略的增量成本效用比下降，但是筛查后接种策略依然优于100%接种策略。结论 15~49岁女性人群筛查后接种戊肝疫苗是最优免疫策略，但会受到价格和接种依从性的影响。 |
| 英文摘要: |
| Objective To evaluate the cost-utility of different hepatitis E vaccination strategies in women aged 15 to 49. Methods The Markov-decision tree model was constructed to evaluate the cost-utility of three hepatitis E virus vaccination strategies. Parameters of the models were estimated on the basis of published studies and experience of experts. Both methods on sensitivity and threshold analysis were used to evaluate the uncertainties of the model. Results Compared with non-vaccination group, strategy on post-screening vaccination with rate as 100%, could save 0.10 quality-adjusted life years per capital in the women from the societal perspectives. After implementation of screening program and with the vaccination rate reaching 100%, the incremental cost utility ratio (ICUR) of vaccination appeared as 5 651.89 and 6 385.33 Yuan/QALY, respectively. Vaccination post to the implementation of a screening program, the result showed better benefit than the vaccination rate of 100%. Results from the sensitivity analysis showed that both the cost of hepatitis E vaccine and the inoculation compliance rate presented significant effects. If the cost were lower than 191.56 Yuan (RMB) or the inoculation compliance rate lower than 0.23, the vaccination rate of 100% strategy was better than the post-screening vaccination strategy, otherwise the post-screening vaccination strategy appeared the optimal strategy. Conclusion Post-screening vaccination for women aged 15 to 49 from social perspectives seemed the optimal one but it had to depend on the change of vaccine cost and the rate of inoculation compliance. |
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