CAJ | 학술논문

目的对中国儿童乙型肝炎(乙肝)疫苗免疫预防14年(1992-2005年)效果评估和对现行的乙肝疫苗接种方案进行优化.方法构建适合中国乙肝疫苗免疫预防实际效果评估和方案优化决策树模型,模型中参数根据相关研究文献或由专业机构提供.主要分析指标为成本效果比(CER)和效益成本比(BCR),用敏感度分析和阈值分析对各参数影响大小进行评估. 结果 14年间,中国直接和间接地用于新生儿乙肝疫苗接种总投入约为53.48亿元,而获得的总效益达2728.25亿元,即乙肝疫苗接种的净效益为2674.77亿元;同期由于疫苗接种避免发生HBV感染约6523万人,每预防一例HBV感染的费用为81.99元,但每投入1元获得的收益为51.01元.中国现行乙肝疫苗接种采用新生儿3剂5 μg,并于出生24 h内完成第一针;对孕妇筛检HBsAg,阳性者新生儿加注一剂乙肝免疫球蛋白(HBIG)均为最优方案.而新生儿以外的1～60岁人群乙肝疫苗接种仍町以获得正效益,尤其是在20岁以前接种效益更明显;但"筛检后再接种"均优于"直接接种". 结论中国既往14年间在新生儿中实行的乙肝疫苗接种策略,从实际的预防效果和投资的经济效益看都是值得的;现行的新生儿优先接种并保持高覆盖率的策略仍为合理方案.
목적 대중국인동을형간염(을간)역묘면역예방14년(1992-2005년)효과평고화대현행적을간역묘접충방안진행우화.방법 구건괄합중국을간역묘면역예방실제효과평고화방안우화결책수모형,모형중삼수근거상관연구문헌혹유전업궤구제공.주요분석지표위성본효과비(CER)화효익성본비(BCR),용민감도분석화역치분석대각삼수영향대소진행평고. 결과 14년간,중국직접화간접지용우신생인을간역묘접충총투입약위53.48억원,이획득적총효익체2728.25억원,즉을간역묘접충적정효익위2674.77억원;동기유우역묘접충피면발생HBV감염약6523만인,매예방일례HBV감염적비용위81.99원,단매투입1원획득적수익위51.01원.중국현행을간역묘접충채용신생인3제5 μg,병우출생24 h내완성제일침;대잉부사검HBsAg,양성자신생인가주일제을간면역구단백(HBIG)균위최우방안.이신생인이외적1～60세인군을간역묘접충잉정이획득정효익,우기시재20세이전접충효익경명현;단"사검후재접충"균우우"직접접충". 결론 중국기왕14년간재신생인중실행적을간역묘접충책략,종실제적예방효과화투자적경제효익간도시치득적;현행적신생인우선접충병보지고복개솔적책략잉위합리방안.
Objective To evaluate the outcome of hepatitis B vaccination strategies performed over the past 14 years and different alternatives recommended for future immunization programs from the point of view of economic efficacy.Methods Methods used would include:process of decision analysis including building the tree:populating the model with parameters;estimating expected cost benefit and effectiveness and deterministic and probabilistic sensitivity and threshold analysis.Results In China，over the past 14 vears from 1992 to 2005.around 5.348 billion Chinese Yuan were provided for hepatitis B vaccination but the total benefits were 272.825 billion Yuan,with net benefits as 267.477 billion Yuan.The cost for each infection averted was 81.99 Yuan while the benefit of one Yuan being invested had 51.01 Ynan in return.For the future recommendations,data from the study revealed that the priority of hepatitis B vaccination for new borns and vaccinations plus passive immunization of newborns of HBsAg positive mothers were most effective approaches.If the other population as adolescents was included into the vaccination program,then screening for hepatitis B virus markers before accepting the vaccination appeared to be one of the most cost-saving strategies.Sensitivity and threshold analyses showed that hepatitis B virus marker Was the most important factor,followed by the cost of vaccine,vaccination coverage and vaccine efficacy,in order.Conclusion Routine vaccination of infants in successive birth cohorts to prevent HBV transmission was a cost-effective strategy administrated over the past 14 years in China.In the following years,the immunization of newborns was still the preferential strategy from a societal perspective.However,vaccination provided to other population including adolescents seemed economically less attractive.