摘要目的 通过评估乙型肝炎(乙肝)母婴阻断策略的经济效益和健康效果,明确成本效益分析(CBA)和成本效果分析(CEA)的适用条件及其在策略定量优化中的作用.方法 根据乙肝免疫预防决策分析Markov模型原理,以乙肝母婴阻断为研究策略,分别与普种策略、不接种作参比确定模型,引入深圳市乙肝免疫预防相关参数后,用2013年出生人数作为队列人群,计算净现效益(NPV)、效益成本比(BCR)和增量成本效果比(ICER),同时进行CBA和CEA的比较和评估.结果 所构建的决策分析模型为一级决策树,HBV感染后转归用3类Markov模型模拟.深圳市2013年乙肝母婴阻断策略获得人均净现效益38 097.51元,BCR为14.37;而普种策略人均获得净现效益37 083.03元,BCR为12.07,即乙肝母婴阻断能带来更多的经济效益.与普种策略比较,乙肝母婴阻断策略每增加一个质量调整寿命年(QALY)人均可节省费用85 100.00元,表明该策略具有明显的经济效果.乙肝母婴阻断策略CBA和CEA影响因素中,最重要的参数为疫苗接种率和乙肝相关疾病费用;CEA模型中所有参数联合变动获得的结果显示,乙肝母婴阻断策略获得的增量效果与节省的成本成正比.结论 乙肝母婴阻断策略能够获得更多的经济效益和健康效果,值得大力推广;但该策略节省的人均成本高于普种策略,确保新生儿乙肝疫苗高覆盖率仍然重要.CBA侧重方案优化,CEA偏向策略比较,两者结合可使经济学评价更加丰富.

abstractsObjective Through cost-benefit analysis (CBA),cost-effectiveness analysis (CEA) and quantitative optimization analysis to understand the economic benefit and outcomes of strategy regarding preventing mother-to-child transmission (PMTCT) on hepatitis B virus.Methods Based on the principle of Hepatitis B immunization decision analytic-Markov model,strategies on PMTCT and universal vaccination were compared.Related parameters of Shenzhen were introduced to the model,a birth cohort was set up as the study population in 2013.The net present value (NPV),benefit-cost ratio (BCR),incremental cost-effectiveness ratio (ICER) were calculated and the differences between CBA and CEA were compared.Results A decision tree was built as the decision analysis model for hepatitis B immunization.Three kinds of Markov models were used to simulate the outcomes after the implementation of vaccination program.The PMTCT strategy of Shenzhen showed a net-gain as 38 097.51 Yuan/per person in 2013,with BCR as 14.37.The universal vaccination strategy showed a net-gain as 37 083.03 Yuan/per person,with BCR as 12.07.Data showed that the PMTCT strategy was better than the universal vaccination one and would end with gaining more economic benefit.When comparing with the universal vaccination program,the PMTCT strategy would save 85 100.00 Yuan more on QALY gains for every person.The PMTCT strategy seemed more cost-effective compared with the one under universal vaccination program.In the CBA and CEA hepatitis B immunization programs,the immunization coverage rate and costs of hepatitis B related diseases were the most important influencing factors.Outcomes of joint-changes of all the parameters in CEA showed that PMTCT strategy was a more cost-effective.Conclusions The PMTCT strategy gained more economic benefit and effects on health.However,the cost of PMTCT strategy was more than the universal vaccination program,thus it is important to pay attention to the process of PMTCT strategy and the universal vaccination program.CBA seemed suitable for strategy optimization while CEA was better for strategy evaluation.Hopefully,programs as combination of the above said two methods would facilitate the process of economic evaluation.