麻疹疫苗干预后的卫生经济学评价

发布时间：2018-07-12 17:24

本文选题：麻疹疫苗 + 短期效果　；参考：《浙江大学》2007年硕士论文

【摘要】： 目的随着麻疹疫苗的大规模接种,麻疹发病有显著的下降,但近几年麻疹疫情形势依然严峻,发病数居高不下,正常的季节分布被打破,严重的不良反应时有发生。不少专家和领导关注现阶段麻疹疫苗接种是否能消除或控制麻疹,接种成本和效益比较是否经济合理。为进一步有效控制麻疹的发病,评价现阶段接种麻疹疫苗的卫生经济学指标,特组织此次研究。方法抽取每个县区选取3家接种单位和市县疾控中心为调查对象,调查2006年疫苗使用成本、冷链设备价值折旧等八个方面。调查覆盖的疫苗品种为国家和省免疫规划的七种疫苗。调查了321例2006年麻疹的治疗费用和陪护人工损失和每日交通费用情况,病例覆盖了2006年杭州市麻疹发病的所有病例(除部分调查中失访的病例)。分析杭州市连续15年八月龄儿童麻疹疫苗基础免疫效果数据,列举了其它同类研究HI检测麻疹疫苗初免前后血凝抑制抗体水平结果,分析了免前抗体滴度与免后抗体滴度的相关关系,免前滴度与阳转率、免后保护率的相关性关系,并对免前滴度与抗体滴度增长倍数两者的关系进行了曲线拟合,以求出麻疹疫苗免疫后短期效果。以杭州市1950～2006年疫情资料为基础,分别用“指数平滑法”(EXSMOOTH)、“易感人群减少法”和“中位数法”来预测麻疹发病数,计算减少发病例数。以统计局公布的国民生产总值、人均国民收入、城乡居民人均消费支出计算避免陪护误工而创造的产值和减少死亡所能创造的产值。结果根据成本费用调查结果,2006年麻疹疫苗预防接种成本费用共需6132091元,其中疫苗成本为431925元,家长陪护损失工时费3527437元。汇总15年1027对免疫效果监测数据得出,麻疹接种后一个月后达到1:2保护水平的有93.48%;文件检索后同类研究的免后平均保护率达到96.60%,将免前滴度作对数转换,用X表示log10(免前滴度),再用变量Z表示免疫接种前后抗体滴度之比,最后用变量X和Z分别做直线方程、对数方程、等比级数曲线模型和指数方程,发现指数曲线的拟合优度相对较好,并有统计学意义,指数方程为Z=14.1087X-0.8837。分别用不同方法推算麻疹疫苗接种后病例减少数,用simple法推算年均减少发病17002.70例;用holt法推算1年均减少发病9337.59例。用易感人群减少法推算麻疹发病减少数5090人。以大规模按月接种麻疹疫苗前的1951年到1983年的发病率中位数235.04/十万来推算,在接下来的23年平均每年减少发病13357人。直接经济效益计算,根据调查结果平均每例麻疹的治疗费用和易感人群减少法推算的减少发病数得出减少直接治疗费用损失9482670元。陪护误工损失费2809720.5元,养育损失费6200元,治疗过程中的交通损失费用681554.3元。汇总得出直接效益12980145元。间接经济效益,根据治疗费用调查结果,避免陪护误工能创造的产值6721595.5元,减少死亡所能创造产值4720342.1元,以上2项合计避免间接经济损失11441937.6元。总效益,①净效益=直接收益+间接收益-成本=12980145+11441937.6-6132091=18289992元②成本与总效益比值=成本/总效益=6132091/18289992=1/2.98。结论在现阶段接种麻疹疫苗仍有较好的卫生经济学效益。
[Abstract]:Objective with the large-scale vaccination of measles vaccine, the incidence of measles has decreased significantly, but in recent years the situation of measles epidemic situation is still severe, the incidence of the disease is still high, the normal seasonal distribution is broken and the serious adverse reaction occurs. Many experts and leaders pay attention to the current stage of measles vaccination to eliminate or control measles and inoculate In order to further effectively control the incidence of measles, to evaluate the health economic indicators of measles vaccine at the present stage, this study is a special organization. Methods 3 inoculation units and city and county CDC in each county were selected to investigate the cost of vaccine use in 2006, the depreciation of cold chain equipment, and so on. Eight. The survey covered seven vaccines for national and provincial immunization programs. 321 cases of measles treatment costs, artificial loss and daily traffic cost in 2006 were investigated. All cases of measles in Hangzhou were covered by all cases in 2006 (except for cases lost in some surveys). The analysis of Hangzhou city for 15 years eight consecutive years. The results of the basic immunization effect of measles vaccine in children of the month of age were given, and the results of the blood coagulation inhibition antibody level before and after the detection of measles vaccine before and after HI were enumerated, and the correlation between the titer of the pre free antibody and the titer of the post immune antibody, the correlation between the pre free titer and the positive conversion rate, the post free protection rate, and the increase of the titer and the titer of the antibody were also analyzed. The relationship between the long multiple of the two was fitted to the short-term effect of the measles vaccine. Based on the data of the 1950~2006 year epidemic situation in Hangzhou, the number of measles was predicted by the "exponential smoothing method" (EXSMOOTH), the method of "susceptible population reduction" and "median method", and the number of cases was reduced. Gross national product (GNP), per capita national income, and per capita consumption expenditure of urban and rural residents can be calculated to avoid the output value created by escort, and to reduce the output value created by death. Results according to the cost and cost survey results, the cost and cost of measles vaccine inoculation needed 6132091 yuan in 2006, and the cost of the vaccine was 431925 yuan. 3527437 yuan ($3527437). A total of 15 years of immunization monitoring data were collected. 93.48% of the 1:2 protection level was reached one month after the measles inoculation. The average post free protection rate of the similar study after the file retrieval was 96.60%, the pre free titer was used as the logarithmic conversion, the log10 was expressed with X, and the variable Z was used to indicate the titer of antibody before and after immunization. In the end, the linear equation, the logarithm equation, the equivalent series curve model and the exponential equation are used respectively with variable X and Z. The goodness of fit of the exponential curve is found to be relatively good and has statistical significance. The exponential equation is used to calculate the number of cases after measles vaccine inoculation by different methods, and the average annual decrease is calculated by simple method. The incidence of 17002.70 cases was calculated by Holt method, and 9337.59 cases were reduced in 1 years. The incidence of measles was reduced by 5090. The median rate of 235.04/ one hundred thousand from 1951 to 1983 before the measles vaccination was calculated, and 13357 people were reduced annually for the next 23 years. Direct economic benefits were reduced. Calculation, according to the results of the investigation, the average cost of each case of measles and the reduction of the incidence of susceptible population reduction were 9482670 yuan to reduce the cost of direct treatment, 2809720.5 yuan for the loss of escort, 6200 yuan for the cost of breeding and 681554.3 yuan for the loss of traffic in the treatment process. The direct benefit was 12980145 yuan. Economic benefits, according to the results of the treatment cost survey, avoid the output value created by escort workers 6721595.5 yuan, reduce death to create output value of 4720342.1 yuan, the above 2 total to avoid indirect economic losses of 11441937.6 yuan. Total benefits, (1) net benefit = direct income + indirect income - the cost of =12980145+11441937.6-6132091=18289992 yuan (2) cost Compared with the total benefit ratio = cost / total benefit =6132091/18289992=1/2.98. conclusion the measles vaccine still has better health economics benefits at this stage.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2007
【分类号】：R186

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