中华流行病学杂志
中華流行病學雜誌
중화류행병학잡지
CHINESE JOURNAL OF EPIDEMIOLOGY
2013年
3期
273-278
,共6页
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
乙型病毒性肝炎%母嬰傳播%疫苗免疫%成本效益分析%決策分析%馬爾科伕模型
을형병독성간염%모영전파%역묘면역%성본효익분석%결책분석%마이과부모형
Hepatitis B virus%Maternal-infantile transmission%Vaccination%Cost-benefit analysis%Decision analysis%Markov model
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.
目的 綜閤各種HBV母嬰傳播阻斷的影響因素,評價母嬰傳播阻斷方案成本效益併明確其優選方案.方法 構建符閤中國實際的HBV母嬰傳播阻斷策略決策樹馬爾科伕模型(其中參數依據Meta分析、現場調查和文獻查閱等方法確定);HBV母嬰傳播阻斷方案的優化指標包括總成本、總效益、淨效益值及效益成本比(BCR),併對模型中的參數對優化方案的影響進行敏感性分析.結果 針對中國現階段6種可能的HBV母嬰傳播阻斷方案,構建瞭多級決策樹模型;分彆攷慮瞭HBsAg和HBeAg篩檢、不同劑量(次)乙型肝炎(乙肝)疫苗和免疫毬蛋白(HBIG)的選用情況.6種方案的BCR均大于1,可穫得的效益均超過成本至少4倍.各方案中以孕婦篩查HBsAg,HBsAg暘性新生兒接種10 μg×3乙肝疫苗加一劑100 IU HBIG,HBsAg陰性新生兒接種10 μg×3乙肝疫苗的方案最優.HBV母嬰傳播阻斷方案中,採用100 IU或200 IU的HBIG,其BCR相近;採用l劑次HBIG(100 IU或200 IU)其BCR均高于2劑次.敏感性分析顯示,參數對優化方案的影響大小依次為接種率、母嬰傳播阻斷率、HBsAg暘性率、乙肝相關疾病經濟負擔、貼現率、接種費和篩檢費,其中接種率和阻斷率為HBV母嬰傳播阻斷優化方案中最重要的影響因素.結論 孕婦篩檢HBsAg,新生兒採用10 μg乙肝疫苗聯閤100 IU的HBIG是HBV母嬰傳播阻斷的最優方案;方案中的接種率和阻斷效率,是確保HBV母嬰傳播阻斷的關鍵.
목적 종합각충HBV모영전파조단적영향인소,평개모영전파조단방안성본효익병명학기우선방안.방법 구건부합중국실제적HBV모영전파조단책략결책수마이과부모형(기중삼수의거Meta분석、현장조사화문헌사열등방법학정);HBV모영전파조단방안적우화지표포괄총성본、총효익、정효익치급효익성본비(BCR),병대모형중적삼수대우화방안적영향진행민감성분석.결과 침대중국현계단6충가능적HBV모영전파조단방안,구건료다급결책수모형;분별고필료HBsAg화HBeAg사검、불동제량(차)을형간염(을간)역묘화면역구단백(HBIG)적선용정황.6충방안적BCR균대우1,가획득적효익균초과성본지소4배.각방안중이잉부사사HBsAg,HBsAg양성신생인접충10 μg×3을간역묘가일제100 IU HBIG,HBsAg음성신생인접충10 μg×3을간역묘적방안최우.HBV모영전파조단방안중,채용100 IU혹200 IU적HBIG,기BCR상근;채용l제차HBIG(100 IU혹200 IU)기BCR균고우2제차.민감성분석현시,삼수대우화방안적영향대소의차위접충솔、모영전파조단솔、HBsAg양성솔、을간상관질병경제부담、첩현솔、접충비화사검비,기중접충솔화조단솔위HBV모영전파조단우화방안중최중요적영향인소.결론 잉부사검HBsAg,신생인채용10 μg을간역묘연합100 IU적HBIG시HBV모영전파조단적최우방안;방안중적접충솔화조단효솔,시학보HBV모영전파조단적관건.
Objective To synthesize relevant data and to analyze the benefit-cost ratio on strategies related to preventing the maternal-infantile transmission of hepatitis B virus infection and to explore the optimal strategy.Methods A decision tree model was constructed according to the strategies of hepatitis B immunization and a Markov model was conducted to simulate the complex disease progress after HBV infection.Parameters in the models were drawn from meta-analysis and information was collected from field study and review of literature.Economic evaluation was performed to calculate costs,benefit,and the benefit-cost ratio.Sensitivity analysis was also conducted and a tornado graph was drawn.Results In view of the current six possible strategies in preventing maternal-infantile transmission of hepatitis B virus infection,a multi-stage decision tree model was constructed to screen hepatitis B surface antigen (HBsAg) or screen for HBsAg then hepatitis B e antigen (HBeAg).Dose and the number of injections of HBIG and hepatitis B vaccine were taken into consideration in the model.All the strategies were considered to be cost-saving,while the strategy of screening for HBsAg and then offering hepatitis B vaccine of 10 μg × 3 for all neonates with hepatitis B immunoglobulin (HBIG) of 100 IU × 1 for the neonates born to mothers who tested positive for HBsAg appeared with most cost-saving.In the strategies,the benefit-cost ratio of using 100 IU HBIG was similar to 200 IU HBIG,and one shot of HBIG was superior to two shots.Results from sensitivity analysis suggested that the rates of immunization and the efficacy of the strategy in preventing maternal-infantile transmission were the main sensitive variables in the model.Conclusion The passive-active immune-prophylaxis strategy that using 10μg hepatitis B vaccine combined with 100 IU HBIG seemed to be the optimal strategy in preventing maternal-infantile transmission,while the rates of immunization and the efficacy of the strategy played the key roles in choosing the ideal strategy.