中国15岁以上人群乙型肝炎免疫预防的决策分析模型研究
发布时间：2018-07-21 10:02
【摘要】：目的建立我国15岁以上人群乙型肝炎免疫预防的决策树-马尔科夫模型,并对我国15岁以上人群乙肝免疫预防的各种方案进行综合评价,筛选出最佳方案,为卫生行政部门制定乙型肝炎免疫接种策略提供依据。 方法通过现场调查,确定不同HBV感染状态的经济负担,利用Meta分析的方法综合国内外与乙肝相关的研究,计算HBV感染率和抗-HBs阳转率,同时考虑疫苗接种率、乙肝年新感染率、疫苗和接种费、筛检费、贴现率、以及感染HBV后各转归率等因素,构建我国15岁以上人群乙肝疫苗免疫预防决策树-马尔科夫模型,运用TreeAge2009软件对模型的各节点的益损值进行计算,并用效益成本比作为评价各方案优劣的指标,对方案进行优选,通过灵敏度分析探讨不同因素对模型影响的大小。 结果1、我国15岁以上人群乙肝免疫预防策略是筛检后接种优于直接接种,且筛检后接种的BCR都大于1,直接接种的BCR都小于1。 2、我国15岁以上人群乙肝免疫预防的最佳接种策略是筛检3项（抗-HBs,HBsAg,抗-HBc)后按0－1-6月程序接种10μg乙肝疫苗。其中,15-19岁组最佳方案的BCR为2.40,每投入1229.59元,可产生2950.75元的效益,1721.16元的净效益；20-29岁组最佳方案的BCR为3.22,每投入862.56元,可获得2774.04元的效益,1911.49元净效益；30-39岁组最佳方案的BCR为3.81,每投入680.09元,得到2591.16元效益,1191.07元净效益；40-49岁组最佳方案的BCR为3.98,每投入5421.81元,获得2157.92元效益,1615.12元净效益；50岁以上组最佳方案的BCR为3.22,即每投入290.16元,可获得935.20元效益,645.04元的净效益。各年龄组的效益成本比随着年龄的增加而升高,但获得的总效益却越来越低,该结果提示,投入在低年龄组将产生更大的社会效益。 3、根据乙肝免疫预防的各种方案,建立决策树-马尔科夫模型,并运用成本效益分析方法,以BCR为方案评价指标,能较全面的评价各方案的优劣情况。也就是说决策树-马尔科夫模型对乙肝免疫预防策略的量化具有良好的适用性和可靠性 4、模型对各参数的灵敏度大小依次为HBVM阳性率,疫苗接种率和接种后抗-HBs阳转率、疫苗及接种费、筛检费、贴现率、HBV感染费用。 5、HBV感染费中无形费用的加入与否,对乙肝疫苗接种策略的优选顺序暂时没有发现影响。 结论1、我国15岁以上人群乙肝免疫预防策略筛检后接种优于直接接种,其最佳接种方案是筛检3项(抗-HBs, HBsAg,抗-HBc)后按0－1－6月程序接种10μg乙肝疫苗。 2、构建的决策树-马尔科夫模型对我国15岁以上人群乙肝免疫预防策略的定量优化具有良好的适用性和可靠性。 3、对模型影响较大的参数有HBVM阳性率、疫苗接种率和接种后抗-HBs阳转率,而疫苗及接种费、筛检费、贴现率、HBV感染费用对模型影响较小。 4、尚未发现HBV感染费用中无形费用对乙肝疫苗接种方案优选顺序有影响。
[Abstract]:Objective to establish a decision tree-Markov model for hepatitis B immunization prevention among people over 15 years of age in China, and to evaluate comprehensively the various schemes of hepatitis B immunization prevention among people over 15 years old in China, and to screen out the best scheme. To provide basis for health administration to formulate hepatitis B immunization strategy. Methods the economic burden of different HBV infection status was determined by field investigation. The HBV infection rate and anti-HBs positive rate were calculated by meta-analysis, and the new HBV infection rate in the year of hepatitis B was taken into account. Based on the factors of vaccine and inoculation cost, screening fee, discount rate, and the rate of HBV infection, the decision tree of hepatitis B vaccine immunization prevention was constructed in China, and the Markov model of hepatitis B vaccine prevention decision tree was established in the population over 15 years of age. TreeAge2009 software is used to calculate the benefit and loss value of each node of the model, and the ratio of benefit to cost is used as the index to evaluate the merits and demerits of each scheme. The scheme is selected optimally, and the influence of different factors on the model is discussed through sensitivity analysis. Results 1. The immunization prevention strategy of hepatitis B in the population over 15 years old in China was better than direct inoculation after screening. The BCR inoculated after screening were all greater than 1, and the BCR inoculated directly were all less than 1.2. The best vaccination strategy for hepatitis B vaccination in China aged 15 years and above was to screen 3 items (anti-HBc) and then inoculate 10 渭 g hepatitis B vaccine according to 0-1-6 months program. The BCR of the best scheme for 15-19 years old group is 2.40. For each investment of 1229.59 yuan, it can produce 2950.75 yuan benefit and 1721.16 yuan net benefit. The BCR of the best scheme for 20-29 years old group is 3.22. For every investment of 862.56 yuan, the net benefit of 2774.04 yuan can be obtained. The BCR of the best scheme for 30-39 years old group is 3.81, with 680.09 yuan per investment, 2591.16 yuan net benefit is 1191.07 yuan net benefit. The best scheme for 40-49 years old group is 3.98. For each investment of 5421.81 yuan, the net benefit of 2157.92 yuan benefit is 1615.12 yuan. The BCR of the best scheme for the group over 50 years old is 3.22, that is, the net benefit of 935.20 yuan can be obtained for every 290.16 yuan invested. The ratio of benefit to cost of each age group increases with age, but the total benefit is getting lower and lower. The results suggest that investing in the lower age group will result in greater social benefits. 3 according to the various programs of hepatitis B immunization prevention, The decision tree-Markov model is established and the method of cost-benefit analysis is used to evaluate the merits and demerits of each scheme with BCR as the evaluation index. That is to say, the decision tree-Markov model has good applicability and reliability for quantification of hepatitis B immune prevention strategy. The sensitivity of the model to each parameter is HBVM positive rate in turn. Vaccination coverage rate, anti-HBs positive conversion rate after vaccination, vaccine and inoculation fee, screening fee, discount rate and HBV infection cost. 5 whether the invisible cost of HBV infection cost was added or not had no effect on the optimal selection order of HBV vaccination strategy for the time being. Conclusion 1. Vaccination after screening is better than direct inoculation in the population over 15 years of age in China. The best inoculation scheme was to screen 3 items (anti-HBs, HBsAg, anti-HBc) and then inoculate 10 渭 g hepatitis B vaccine according to the procedure of 0-1-6 months. 2. The decision tree Markov model was constructed to prevent hepatitis B in the population over 15 years of age in China. The quantitative optimization has good applicability and reliability. 3. The positive rate of HBVM has been found in the parameters that have a great influence on the model. Vaccination rate and positive rate of anti-HBs after vaccination, and cost of vaccine and inoculation, screening cost, The discount rate and the cost of HBV infection had little effect on the model. 4. It was not found that the invisible cost of HBV infection cost had influence on the selection sequence of hepatitis B vaccination program.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R392.1
本文编号：2135164
[Abstract]:Objective to establish a decision tree-Markov model for hepatitis B immunization prevention among people over 15 years of age in China, and to evaluate comprehensively the various schemes of hepatitis B immunization prevention among people over 15 years old in China, and to screen out the best scheme. To provide basis for health administration to formulate hepatitis B immunization strategy. Methods the economic burden of different HBV infection status was determined by field investigation. The HBV infection rate and anti-HBs positive rate were calculated by meta-analysis, and the new HBV infection rate in the year of hepatitis B was taken into account. Based on the factors of vaccine and inoculation cost, screening fee, discount rate, and the rate of HBV infection, the decision tree of hepatitis B vaccine immunization prevention was constructed in China, and the Markov model of hepatitis B vaccine prevention decision tree was established in the population over 15 years of age. TreeAge2009 software is used to calculate the benefit and loss value of each node of the model, and the ratio of benefit to cost is used as the index to evaluate the merits and demerits of each scheme. The scheme is selected optimally, and the influence of different factors on the model is discussed through sensitivity analysis. Results 1. The immunization prevention strategy of hepatitis B in the population over 15 years old in China was better than direct inoculation after screening. The BCR inoculated after screening were all greater than 1, and the BCR inoculated directly were all less than 1.2. The best vaccination strategy for hepatitis B vaccination in China aged 15 years and above was to screen 3 items (anti-HBc) and then inoculate 10 渭 g hepatitis B vaccine according to 0-1-6 months program. The BCR of the best scheme for 15-19 years old group is 2.40. For each investment of 1229.59 yuan, it can produce 2950.75 yuan benefit and 1721.16 yuan net benefit. The BCR of the best scheme for 20-29 years old group is 3.22. For every investment of 862.56 yuan, the net benefit of 2774.04 yuan can be obtained. The BCR of the best scheme for 30-39 years old group is 3.81, with 680.09 yuan per investment, 2591.16 yuan net benefit is 1191.07 yuan net benefit. The best scheme for 40-49 years old group is 3.98. For each investment of 5421.81 yuan, the net benefit of 2157.92 yuan benefit is 1615.12 yuan. The BCR of the best scheme for the group over 50 years old is 3.22, that is, the net benefit of 935.20 yuan can be obtained for every 290.16 yuan invested. The ratio of benefit to cost of each age group increases with age, but the total benefit is getting lower and lower. The results suggest that investing in the lower age group will result in greater social benefits. 3 according to the various programs of hepatitis B immunization prevention, The decision tree-Markov model is established and the method of cost-benefit analysis is used to evaluate the merits and demerits of each scheme with BCR as the evaluation index. That is to say, the decision tree-Markov model has good applicability and reliability for quantification of hepatitis B immune prevention strategy. The sensitivity of the model to each parameter is HBVM positive rate in turn. Vaccination coverage rate, anti-HBs positive conversion rate after vaccination, vaccine and inoculation fee, screening fee, discount rate and HBV infection cost. 5 whether the invisible cost of HBV infection cost was added or not had no effect on the optimal selection order of HBV vaccination strategy for the time being. Conclusion 1. Vaccination after screening is better than direct inoculation in the population over 15 years of age in China. The best inoculation scheme was to screen 3 items (anti-HBs, HBsAg, anti-HBc) and then inoculate 10 渭 g hepatitis B vaccine according to the procedure of 0-1-6 months. 2. The decision tree Markov model was constructed to prevent hepatitis B in the population over 15 years of age in China. The quantitative optimization has good applicability and reliability. 3. The positive rate of HBVM has been found in the parameters that have a great influence on the model. Vaccination rate and positive rate of anti-HBs after vaccination, and cost of vaccine and inoculation, screening cost, The discount rate and the cost of HBV infection had little effect on the model. 4. It was not found that the invisible cost of HBV infection cost had influence on the selection sequence of hepatitis B vaccination program.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R392.1
【引证文献】
相关期刊论文 前1条
1 张吉凯;郑慧贞;梁剑;夏艳辉;;甲肝减毒活疫苗纳入广东省扩大免疫规划项目成本-效益分析[J];中国卫生经济;2013年07期
相关博士学位论文 前2条
1 朱大伟;使用者付费下农村地区成人乙肝疫苗利用、需求和接种机构选择研究[D];山东大学;2013年
2 吕静静;山东省新生儿乙肝疫苗免疫策略经济学评价研究[D];山东大学;2013年
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