柳州市人群甲型肝炎疫苗接种的流行病学及费用效果分析

李新华; 徐志一; Albert Hofman; 李荣成; 赵守军; 李艳萍; 王克安

Abstract

李新华,徐志一,Albert Hofman,李荣成,赵守军,李艳萍,王克安.柳州市人群甲型肝炎疫苗接种的流行病学及费用效果分析[J].Chinese journal of Epidemiology,1998,19(2):93-96

柳州市人群甲型肝炎疫苗接种的流行病学及费用效果分析

Epidemiology and Cost-Eff ectiveness Analysis of Hepatitis A Vaccination in Liuzhou City

Received:May 10, 1997 Revised:July 25, 1997

DOI：

KeyWord: 病毒性肝炎预防接种流行病学费用效果分析

English Key Word: Hepatitis Vaccina tio n Epidemio lo gy Co st-effectiv eness

FundProject:中华医学基金会和九·五攻关资助

Author Name	Affiliation
Li Xin- hua	Chinese Academy of Preventive Medicine, Beijing, 100050
Xu Zhiyi	上海医科大学流行病学教研室
Albert H ofman	荷兰鹿特丹Erasmus大学医学院
李荣成	广西壮族自治区卫生防疫站肝炎科
赵守军	上海医科大学流行病学教研室
李艳萍	广西壮族自治区卫生防疫站肝炎科
王克安	Chinese Academy of Preventive Medicine, Beijing, 100050

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Abstract:

分 7个不同的年龄组队列,比较接种甲型肝炎 (甲肝 )减毒活疫苗 ( H2 株 )后 15年每一队列人群接种与否甲肝感染及发病的差异,并根据甲肝患病及甲肝疫苗接种的医疗费用和对质量修正生命年 ( QAL Y)的影响,推算接种的费用效果比 ( CER)。不接种情况下推算的不同年龄别人群发病率与本次研究人群的实际资料接近,说明计算模型可靠。基础假设的结果显示,每获得一个QAL Y,全人口组的平均费用是 152 2 77.60元,超过同期人均生产总值的 11倍。各年龄组单位效果的费用变化范围从 113369.30元 ( 10～ 19岁组 )到 2 92 138.30元 (≥ 50岁组 )。但对高危人群接种的分析显示,其 CER显著改善。所以,甲肝疫苗在中等疫情的城市人群中普遍使用是不合算的 ;预防接种应只面向高危人群。另外,灵敏度分析显示主要参数的改变均不会改变本文的结论。

English Abstract:

The changes of annual incidence rates were predicted for 7 cohorts of different ageseither with or without vaccination. Costeffectiveness ratio ( CER) was estimated by the annual differences of HA incidence of the two scenarios at 15 years after in oculation, the medical costs and quality of life impact ( Q ALY) for conditions related to the vaccination and disease. The estima tedag e specific HA incidence rates o f the co hor ts witho ut vaccination fitted the observed age specific HA incidence rates quite well, indicating the correctness of our calculation models. Under the basecase assumptions, vaccination in gene ralpopulation would entail medical costs. The avrage CER.was 153 277. 6 Yuan /Q ALY, 11 times more than the average per-capita GN Pin 1994. The basecase CER svaried from 113 369. 3 Yuan /QALY in 10-19 years of age to 292 138. 3 Yuan /QALY in age group 50- years. Howev er, much better CERs are found when vaccination is directed toward a high risk population. In this case, widespread use of HAV vaccine in gene ral population with intermediateepidemicity would not be cost-effective while it should be only focused on the high risk po pulation. Sensitivity analysis showed that none of the basic variables might change this co nclusion.

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