我国艾滋病母婴阻断的卫生经济学评价

发布时间：2018-11-27 12:34

【摘要】：研究背景通过综合母婴阻断策略,可以将艾滋病母婴传播率降低到2%以下,我国政府自2010年起,加大了对艾滋病母婴阻断项目的投入,约占艾滋病总防治经费的三分之一。针对艾滋病母婴阻断策略科学的经济学评价,有助于了解该项策略投入产出的量化关系,为决策者配置资源提供可靠的证据和信息。研究目的分析评价我国艾滋病母婴阻断项目的成本效果,探索适合于我国目前经济发展水平的艾滋病母婴阻断策略。研究方法根据研究目的,采用文献检索、现场调查、专家咨询等途径收集各状态转移概率和成本数据,在此基础上建立Markov模型,设置三种不同母婴阻断策略,即综合母婴阻断策略,临产母婴阻断策略和无阻断策略,模拟艾滋病发展的过程。进行Markov队列分析,综合评价三种策略的成本效果,并计算增量成本效果；对关键变量进行敏感度分析,判断其对结果的影响程度；进行Monte Carlo试验模拟分析,评价成本效果及结果变异程度；进行Monte Carlo概率敏感度分析,综合估计参数不确定时的三个策略的成本效果。研究结果1.假设三个组分别有100,000例孕产妇,Markov队列分析结果显示,综合母婴阻断策略,临产母婴阻断策略和无阻断策略总花费和获得的生命年分别为8,709,349元/2,952,659 QALYs,5,598,963元/2,952,176 QALYs和2,739,870元/2,949,932 QALYs。三个组的成本效果比分别为2.95,1.90和0.09。与无阻断策略相比,综合母婴阻断策略的增量成本效果比(Incremental Cost Effectiveness Ratio, ICER)为2,189元/QALY,临产母婴阻断策略的增量成本效果比为1,274元/QALY。与临产母婴阻断策略相比,综合母婴阻断策略的增量成本效果比为6,439元/QALY。母婴阻断仅影响各个组的初始分布,与无阻断相比,综合母婴阻断策略阻止了72例HIV感染,临产母婴阻断策略阻止了57例HIV感染。与无阻断策略相比,综合母婴阻断策略每挽救一个健康新生儿需要花费约82,909元,临产母婴阻断策略每挽救一个健康新生儿需要花费50,160元。2.敏感度分析结果表明,随着参数的变化,相比其他两种策略,综合母婴阻断策略的增量成本效果始终小于意愿支付值(Willingness To Pay,WTP),其中每挽救一个QALY所需的花费随着孕产妇HIV患病率的增长而降低,随着HIV感染者和AIDS患者疾病负担逐渐增加,综合母婴阻断策略的先期投入会被后期节省的花费抵消,变为节约成本的策略。3.当抽样次数为100,000次时,Monte Carlo试验模拟分析结果表明,综合母婴阻断策略,临产母婴阻断策略和无阻断策略人均花费和获得的生命年分别为86.28元/29.50QALYs,57.34元/29.49 QALYs和29.15元/29.47QALYs,三组的成本效果比分别为2.93,1.94和0.99。临产组和对照组的成本值变异程度较综合组大。综合母婴阻断组相对于对照组和临产阻断组的增量成本效果比分别为1,991元/QALY和5,351元/QALY,临产组相对于对照组的ICER为1,210元/QALY,均小于预设的意愿支付值。4.当抽样样本量为1,000时,Monte Carlo概率敏感度分析结果表明,三个组的人均成本效果值分别为101.34元/29.57QALY,76.77元/29.56QALY和74.79元/29.55QALY.临产组和对照组成本呈明显右偏态分布。意愿支付曲线表明当意愿支付限高于4,000元时,综合母婴阻断组能获得最多的效果。研究结论本研究假设三种母婴阻断策略,发现综合母婴阻断策略符合成本效果,其支出成本在可接受范围内。建议应该继续扩大艾滋病母婴阻断项目的覆盖面,在已覆盖地区,应加强孕产妇宣传教育,探索针对孕产妇人群宣教的有效模式,提高其知晓率,鼓励早期检测。
[Abstract]:Through the comprehensive mother-to-child blocking strategy, the mother-to-child transmission rate of AIDS can be reduced to less than 2%, and the Government of our country, since 2010, has increased the input to the mother-to-child blocking project of AIDS, accounting for about one-third of the total HIV/ AIDS prevention. According to the economic evaluation of the strategy of mother-to-child blocking of AIDS, it is helpful to understand the quantitative relation of input-output of the strategy and provide reliable evidence and information for the decision-maker's allocation of resources. The purpose of this study is to analyze and evaluate the cost effect of the mother-to-child blocking project in China, and to explore the mother-to-child blocking strategy suitable for the current level of economic development in China. according to the purpose of the research, the state transition probability and the cost data are collected by means of a literature search, a field investigation, an expert consultation and the like, a Markov model is established, and three different mother-to-child blocking strategies, namely, a comprehensive mother-to-child blocking strategy, are set up, The mother-to-child blocking strategy and the non-blocking strategy to simulate the development of AIDS. carrying out the Markov-based queue analysis, comprehensively evaluating the cost effect of the three strategies, and calculating the incremental cost effect; carrying out sensitivity analysis on the key variables, and judging the influence degree of the incremental cost; carrying out the Monte Carlo simulation analysis, and evaluating the cost effect and the result variation degree; The method carries out the Monte Carlo probability sensitivity analysis and the cost effect of the three strategies when the comprehensive estimation parameter is uncertain. Study Results 1. It is assumed that there are 100,000 pregnant women in three groups, and the results of the Markov cohort analysis show that the total cost of the comprehensive mother-to-child blocking strategy, the mother-to-child blocking strategy and the total cost of the non-blocking strategy are 8,709,349/ 2,952,659 QALYs, 5,598, 963-yuan/ 2,952,176 QALYs and 2,739,870 yuan/ 2,949,932 QALYs, respectively. The cost-effect ratio of the three groups was 2.95, 1.90 and 0.09, respectively. Compared with the non-blocking strategy, the incremental cost effect ratio (ICER) of the comprehensive mother-to-child blocking strategy is 2,189 yuan/ QALY, and the incremental cost effect ratio of the mother-to-child blocking strategy is 1,274 yuan/ QALY. Compared with the mother-to-child blocking strategy, the incremental cost-effect ratio of the comprehensive mother-to-child blocking strategy is 6,439 Yuan/ QALY. The mother-to-child blocking only affected the initial distribution of the individual groups, and the comprehensive mother-to-child blocking strategy prevented the 72 cases of HIV infection, and the mother-to-child blocking strategy prevented the 57 cases of HIV infection. In comparison with the non-blocking strategy, the comprehensive mother-to-child blocking strategy will take about 82,909 yuan to save a healthy newborn, and the child-to-child blocking strategy will cost a total of 50, 160. The sensitivity analysis results show that, with the change of the parameters, the incremental cost effect of the comprehensive mother-to-child blocking strategy is always less than the will-to-pay (WTP) compared to the other two strategies, in which the cost of every saving one QALY is reduced with the increase of the prevalence of the maternal HIV, With the gradual increase of the disease burden of people living with HIV and AIDS, the advance input of the comprehensive mother-to-child blocking strategy will be offset by the cost savings and become a cost-saving strategy. The results of the Monte Carlo simulation analysis show that the total cost of the comprehensive mother-to-child blocking strategy, the mother-to-child blocking strategy and the non-blocking strategy per capita is 86.28 yuan/ 295.50QALYs, 5734 yuan/ 295.49 QALYs and 295.15 yuan/ 297.47QALYs, respectively, and the cost effect ratio of the three groups is 2.93, 1.94 and 0.99, respectively. The cost value variation of the group and the control group was higher than that of the comprehensive group. The effect of the comprehensive mother-to-infant blocking group on the incremental cost of the control group and the temporary block group was 1, 991 Yuan/ QALY and 5,351 Yuan/ QALY, respectively, and the ICER of the temporary production group with respect to the control group was 1, 210 Yuan/ QALY, which was less than the preset will payment value. When the sample size of the sample is 1,000, the Monte Carlo probability sensitivity analysis results show that the average cost effect of the three groups is 101.34 Yuan/ 295.57QALY, 767.77 Yuan/ 295.56QALY and 74.79 Yuan/ 295.55QALY, respectively. The cost of the control group and the control group was significantly lower than that of the control group. The willingness to pay the curve shows that the comprehensive mother-to-child blocking group can achieve the most effect when the willingness to pay is higher than 4,000 yuan. The results of the study suggest that the three types of mother-to-child blocking strategies are in accordance with the cost effect, and the cost of expenditure is within the acceptable range. It is suggested that the coverage of the mother-to-child blocking project of AIDS should continue to be expanded. In the areas covered, the maternal and child education should be strengthened, the effective mode of education for pregnant and pregnant women should be explored, the awareness rate should be improved, and early detection should be encouraged.
【学位授予单位】：中国疾病预防控制中心
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R512.91

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