我国2006-2030年乙肝免疫预防经济学效果的评价和预测

目的 对我国2006-2030年乙型病毒性肝炎（乙肝）免疫预防经济学效果做出评价和预测，为消除乙肝策略制订提供依据。方法 采用决策分析马尔科夫模型，以新生儿数为队列人群，从医疗卫生和全社会角度计算成本、效益和效果，包括避免的乙肝病毒（hepatitis B virus，HBV）感染数和乙肝相关疾病数，获得的质量调整期望寿命（quality adjusted life years，QALYs）。以多获得一个QALYs所需成本、净效益和效益成本比（benefit cost ratio，BCR）为分析指标。结果 2006-2015年间，从医疗卫生和全社会角度，我国乙肝免疫预防投入分别为6 256.64亿元和8 125.03亿元，净收益为43 571.85亿元和53 703.80亿元，BCR为7.96和7.61；多获得一个QALYs需要的投入分别为6 471.53元和10 023.55元；累积获得0.96亿个QALYs。2016-2030年间，从医疗卫生和全社会角度，所需投入分别为7 500.15亿元和10 290.86亿元，将获净效益72 729.35亿元和89 818.08亿元，BCR分别为9.45和8.79；多获得一个QALYs所需投入分别为5 398.36元和8 389.38元；累积将获得1.37亿个QALYs。结论 我国近10年实施乙肝免疫预防策略，具有较高的成本效益和成本效果价值。未来15年，需要持续高水平实施乙肝免疫预防策略，将会获得更高效益和效果。

Evaluation and forecast for economic outcomes of hepatitis B immunoprophylaxis strategies in China from 2006 to 2030

Objective To evaluate and forecast the economic outcomes of the national hepatitis B immunoprophylaxis strategies from 2006 to 2030, and to promote a nationwide program eliminating hepatitis B launched early in China. Methods The decision analytic-Markov model was used with newborns from 2006 to 2030 as simulation cohort. The cost-effectiveness and cost-benefit analysis were assessed for different scenarios of the last decade and the next fifteen years. The costs and benefits were calculated from the health-care and societal perspectives. The net benefits (NB) and benefit cost ratio (BCR) were considered indicators of cost-benefit analysis. The numbers of hepatitis B virus(HBV)infection and the patients with HBV-related diseases prevented, cumulative quality adjusted life years (QALYs) and the costs per QALYs gained were calculated for cost-effectiveness analysis. Results From 2006 to 2015, the costs of the strategy from two perspectives were RMB 625.664 billion yuan and 812.503 billion yuan, respectively. However, the NB reached up to RMB 4 357.185 billion yuan and 5 370.380 billion yuan, with the BCR of 7.96 and 7.61, respectively. And the costs per QALYs gained were RMB 6 471.53 yuan and 10 023.55 yuan. A total of 96 million QALYs were gained for all birth cohorts. Although the costs with RMB 750.015 billion yuan and 1 029.086 billion yuan will be invested from 2016 to 2030, the more NB with RMB 7 272.935 billion yuan and 8 981.808 billion yuan, the larger BCR with 9.45 and 8.79 and the more QALYs with 137 million will be gained for the strategy implementing sustainably. Also,the RMB 5 398.36 Yuan and 8 389.38 Yuan will be the costs per QALYs gained. Conclusions The national hepatitis B immunoprophylaxis strategies implemented in the last 10 years are with high value of cost-benefit and cost-effectiveness. The strategies will be gained more in the future 15 years, so as to respond the world health organization(WHO)advocacy for eliminating hepatitis B in China.