广州市艾滋病检测策略的卫生经济学评价

发布时间：2018-03-09 17:26

本文选题：艾滋病　切入点：检测　出处：《中国疾病预防控制中心》2013年博士论文　论文类型：学位论文

【摘要】：目的：对调查地区的艾滋病检扩大测策略进行卫生经济学评价,分析其成本-效果和成本效用,为卫生决策部门以后因地制宜的实施或调整该策略提供科学依据。方法：本研究包括两个部分,第一部分是以现场调查为基础,旨在调查选定地区自2006年至2011年底HIV检测策略的实施情况,测算该地区的HIV扩大检测策略的逐年成本投入和总成本投入,收集该地区逐年的检测人次数、检测阳性数以及纳入管理的阳性人数；第二部分为利用Bernoulli-process模型计算因性传播途径所避免的新发感染人数以及因注射吸毒感染途径而避免的新发感染人数。此外,通过构建Markov模型模拟计算获得的质量调整生命年,利用上述数据对广州市2006-2011年HIV检测策略进行成本-效果分析和成本-效用分析。结果：广州市2006-2011年HIV检测策略总的成本投入呈逐年上升趋势,总成本为14849.247万元；2006年总成本投入为1670.483万元,而2011年则上升为3845.237万元。对广州市HIV检测策略进行成本-效果分析,以每新发现一例HIV阳性感染者作为效果指标,广州市2006-2011年的平均成本-效果比为1.380万元/每发现1例HIV感染者；以每将一例阳性病人进纳入到管理体系中作为效果指标,近6年的平均成本-效果比为1.612万元／每纳入1例HIV感染者；以每避免一例HIV阳性感染者作为效果指标,则近6年平均每避免一例新发感染需要花费约为12.703万元,波动范围为1.802万元-62.131万元；通过分析广州市接受HIV检测的人群中HIV血清阳性率与成本-效果比关系得出,随着HIV血清阳性率的降低,每发现一例HIV感染者的成本上升。对广州市HIV检测策略进行成本-效用分析,结果发现：广州市HIV检测措施实施后,若不考虑对HIV感染者随访治疗等费用,则每挽救一个QALY需花费0.221万元；在考虑对HIV感染者/AIDS病人的随访治疗费用的前提下,每挽回一个QALY需要花费1.574万元。结论：广州市HIV检测策略的实施是符合成本效益原则的,应在现有HIV检测策略实施的基础上,进一步扩大HIV检测覆盖面,并加强对重点人群的筛查,以发现更多潜在的HIV感染者。但研究仅调查了广州地区的数据,仍然缺乏不同流行水平和不同经济水平地区的相关证据。应根据HIV不同流行水平和当地不同的经济水平,开展HIV检查策略的卫生经济学评价。
[Abstract]:Objective: to evaluate the strategy of expanding HIV / AIDS testing in the investigation area, analyze its cost effect and cost utility, and provide a scientific basis for the implementation or adjustment of the strategy in accordance with the local conditions in the future. Methods: this study consists of two parts. The first part is based on the field investigation. The purpose of this study is to investigate the implementation of HIV detection strategy in selected areas from 2006 to end of 2011. The annual cost input and total cost input of the expanded HIV detection strategy in this area were calculated, and the number of person-times tested, the number of positive people tested and the number of positive people brought into the management were collected year by year in this area. The second part is to calculate the number of new infections avoided by the route of sexual transmission and the number of new infections avoided by the route of injecting drug use using the Bernoulli-process model. In addition, the quality-adjusted life years obtained by constructing the Markov model are simulated and calculated. The above data are used to analyze the cost-effect and cost-utility of HIV detection strategy in Guangzhou from 2006 to 2011. Results: from 2006 to 2011, the total cost of HIV detection strategy in Guangzhou increased year by year, with the total cost of one hundred and forty-eight million four hundred and ninety-two thousand and four hundred and seventy yuan, sixteen million seven hundred and four thousand and eight hundred and thirty yuan in 2006 and thirty-eight million four hundred and fifty-two thousand and three hundred and seventy yuan in 2011. The cost-effect analysis of HIV detection strategy in Guangzhou was carried out. The average cost-effect ratio between 2006 and 2011 was 13,800 yuan per case of HIV infection. Taking each positive patient into the management system as an effect indicator, the average cost-effect ratio of nearly 6 years was 16,120 yuan per case of HIV infection, and one case of HIV positive infection was avoided as an effect index. The average cost of avoiding a new infection in the past 6 years was about 127,030 yuan, with a fluctuation range of 18,020 yuan to 621,310 yuan. The relationship between the positive rate of HIV serum and the cost-effectiveness ratio among the people who were tested for HIV in Guangzhou City was analyzed. As the HIV seropositive rate decreases, the cost of each case of HIV infection increases. The cost-utility analysis of HIV detection strategy in Guangzhou was carried out. The results showed that if the cost of follow-up treatment for HIV infected persons was not considered, it would cost 2,210 yuan to save a QALY after the implementation of HIV detection measures in Guangzhou; After considering the cost of follow-up treatment for patients with HIV / AIDS, it costs $15,740 for each QALY to be recovered. Conclusion: the implementation of HIV detection strategy in Guangzhou is in line with the principle of cost-effectiveness. Based on the implementation of the existing HIV detection strategy, the coverage of HIV detection should be further expanded, and the screening of key population should be strengthened. In order to find more potential HIV infections, however, the study only investigated data from Guangzhou, and still lacked relevant evidence for different epidemic levels and different economic levels. Different HIV prevalence levels and different local economic levels should be taken into account. To evaluate the health economics of HIV inspection strategy.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R512.91

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