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柳州市人群甲型肝炎疫苗接种的流行病学及费用效果分析 |
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李新华1，2 徐志一2 Albert Hofman3 李荣成4 赵守军2 李艳萍4 王克安1
摘要 分7个不同的年龄组队列，比较接种甲型肝炎(甲肝)减毒活疫苗(H2株)后15年每一队列人群接种与否甲肝感染及发病的差异，并根据甲肝患病及甲肝疫苗接种的医疗费用和对质量修正生命年(QALY)的影响，推算接种的费用效果比(CER)。不接种情况下推算的不同年龄别人群发病率与本次研究人群的实际资料接近，说明计算模型可靠。基础假设的结果显示，每获得一个QALY，全人口组的平均费用是152 277.60元，超过同期人均生产总值的11倍。各年龄组单位效果的费用变化范围从113 369.30元(10～19岁组)到292 138.30元(≥50岁组)。但对高危人群接种的分析显示，其CER显著改善。所以，甲肝疫苗在中等疫情的城市人群中普遍使用是不合算的；预防接种应只面向高危人群。另外，灵敏度分析显示主要参数的改变均不会改变本文的结论。
关键词 病毒性肝炎 预防接种 流行病学 费用效果分析
Epidemiology and Cost-Effectiveness Analysis of Hepatitis A Vaccination in Liuzhou City Li Xinhua*, Xu Zhiyi,Albert Hofman,et al.*Chinese Academy of Preventive Medicine,Beijing,100050
Abstract The changes of annual incidence rates were predicted for 7 cohorts of different ages either with or without vaccination.Cost-effectiveness ratio (CER) was estimated by the annual differences of HA incidence of the two scenarios at 15 years after inoculation,the medical costs and quality of life impact (QALY) for conditions related to the vaccination and disease.The estimated age specific HA incidence rates of the cohorts without vaccination fitted the observed age specific HA incidence rates quite well,indicating the correctness of our calculation models.Under the basecase assumptions,vaccination in general population would entail medical costs.The average CER was 153 277.6 Yuan/QALY,11 times more than the average per-capita GNP in 1994.The basecase CERs varied from 113 369.3 Yuan/QALY in 10-19 years of age to 292 138.3 Yuan/QALY in age group 50- years.However,much better CERs are found when vaccination is directed toward a high risk population.In this case,widespread use of HAV vaccine in general population with intermediate epidemicity would not be cost-effective while it should be only focused on the high risk population.Sensitivity analysis showed that none of the basic variables might change this conclusion.
Key words Hepatitis Vaccination Epidemiology Cost-effectiveness
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