CAJ | 학술논문

目的探讨中国不同抗-HAV流行区儿童普遍接种(普种)甲型肝炎(甲肝)疫苗的成本效用.方法模拟一个100万人的队列、“12+18”个月两针免疫程序,采用决策分析方法,建立马尔科夫决策树模型,以费用为投入指标,显性感染人数、住院人数、损失质量调整寿命年(QALY)、甲肝死亡人数为产出指标,结合增量费用效用分析,基于中国不同抗-HAV流行区的情况,预期未来73年的产出,并与不接种方案比较,选定最佳方案.采用灵敏性分析评估结果的稳定性.结果在抗-HAV低、中低及中度流行区普种甲肝疫苗,其投入和各项产出指标均小于不接种,增量费用效用比(ICUR)均＜0,即接种方案在增加QALY的同时节省费用.在中高度流行区,普种甲肝疫苗的投入小于不接种,显性感染人数、住院人数、损失QALY也小于不接种疫苗,ICUR＜0,但普种后甲肝死亡人数比不接种增加20例.在高度流行区,普种的卫生服务总费用和社会总费用分别比不接种多4 560 814元和5 840430元,但显性感染人数、住院人数、损失QALY也小于不接种,甲肝死亡人数比不接种增加51例,每增加一个QALY的卫生服务费用和社会费用分别为1507元和1929元.灵敏性分析认为结果稳定,疫苗保护年消失率和易感者年感染率是影响决策的灵敏参数.结论中国甲肝不同流行区应根据疫苗保护期限,以抗-HAV阳性率决定是否普种疫苗.
목적 탐토중국불동항-HAV류행구인동보편접충(보충)갑형간염(갑간)역묘적성본효용.방법 모의일개100만인적대렬、“12+18”개월량침면역정서,채용결책분석방법,건립마이과부결책수모형,이비용위투입지표,현성감염인수、주원인수、손실질량조정수명년(QALY)、갑간사망인수위산출지표,결합증량비용효용분석,기우중국불동항-HAV류행구적정황,예기미래73년적산출,병여불접충방안비교,선정최가방안.채용령민성분석평고결과적은정성.결과 재항-HAV저、중저급중도류행구보충갑간역묘,기투입화각항산출지표균소우불접충,증량비용효용비(ICUR)균＜0,즉접충방안재증가QALY적동시절성비용.재중고도류행구,보충갑간역묘적투입소우불접충,현성감염인수、주원인수、손실QALY야소우불접충역묘,ICUR＜0,단보충후갑간사망인수비불접충증가20례.재고도류행구,보충적위생복무총비용화사회총비용분별비불접충다4 560 814원화5 840430원,단현성감염인수、주원인수、손실QALY야소우불접충,갑간사망인수비불접충증가51례,매증가일개QALY적위생복무비용화사회비용분별위1507원화1929원.령민성분석인위결과은정,역묘보호년소실솔화역감자년감염솔시영향결책적령민삼수.결론 중국갑간불동류행구응근거역묘보호기한,이항-HAV양성솔결정시부보충역묘.
Objective To explore the inputs and outputs of areas with different anti-HAY prevalence rates on universal childhood vaccination,and to provide a scientific basis for the formulation of the immunization strategy.Methods Since hepatitis A vaccination was scheduled at 12 and 18 months of age for all the healthy children,a single cohort including 1 000 000 individuals was formed in 2009,using the Chinese inactivated vaccine.Decision analysis was used to build Markov-decision tree model.The universal childhood hepatitis A vaccination was compared with nonvaccination group to evaluate the number of symptomatic infection,hospitalization,death,qualityadjusted life years (QALYs) lost,and the incremental cost-utility from the health system and the societal perspectives.Outcomes of the vaccination for the next 70 years were also predicted.The process of analysis was run separately in five regions defined by the anti-HAV prevalence rates (around 50％,50％-69％,70％-79％,80％-89％ and ＞90％ ).Sensitivity analysis was performed to test the stability or reliability of the results,and to identify sensitive variables.Results The study projected that,in the lowest,lower,and intermediate infection regions,the cost and output indicators of universal childhood hepatitis A vaccination were all lower than non-vaccinated group.Universal vaccination could gain QALYs and save both costs from the health systen or the society.In the regions with higher infection rate,the output indicators of universal childhood hepatitis A vaccination were lower than in those non-vaccinated groups,except for the number of death due to hepatitis A,which had a 20 cases of increase.The model also predicted that in the highest infected region,universal vaccination would increase 4 560 814 and 5 840 430 RMB Yuan in the total costs from both the health system and the societies,respectively,when compared to the non-vaccination groups.Universal vaccination would also decrease the numbers of symptomatic infection,hospitalization,and QALYs lost,but would increase 51 deaths due to hepatitis A,and 1507,1929 more RMB Yuan for each QALY gained from the health system and societal respectively,in the regions with highest infection rate.Sensitivity analyses discovered that the infection rate among those susceptible population and the proportion of those who initially under protection but subsequently lost their immunity every year,were the two main sensitive variables in the model.Conclusion Our research discovered that the universal vaccination strategy should be based on the protective period of the vaccine and the anti-HAV prevalence in different endemic areas.