哈尔滨市农村癫痫患者健康相关生命质量评价研究

目的 评价哈尔滨市农村癫痫患者健康相关生命质量并分析其影响因素。方法 通过简单随机抽样方法，随机选取哈尔滨市236例惊厥型癫痫患者，基于中国人群的EQ-5D效应值积分体系计算癫痫患者健康效应值，采用秩和检验和Tobit回归模型方法对癫痫患者健康水平影响因素进行分析。结果 调查的236名癫痫患者在5个维度有困难者占比排序为:焦虑或沮丧（42.74%）、疼痛或不适（30.77%）、日常活动（28.63%）、自己照顾自己（18.80%）、行动（16.67%），基于中国积分体系计算癫痫患者健康效应值为0.85，Tobit回归模型结果表明，职业（95%CI = 0.004～0.313，P = 0.045）、体育运动（95%CI = 0.001～0.438，P = 0.049）、最近一次发作时间（95%CI = - 0.316～- 0.020，P = 0.027）、总病程（95%CI = - 0.051～- 0.387，P = 0.011）对癫痫患者的健康效用值得分有统计学差异。结论 癫痫对患者心理方面的影响程度大于生理方面，应加大对癫痫患者心理方面的关注。脑力劳动者、体育运动的癫痫患者健康效用值相对较高，发作时间在0～3个月内、总病程较长的癫痫患者健康效用值相对较低。     

卫生经济学评价方法在我国艾滋病防控领域的应用

在艾滋病的防控实践中,常会面临投入不足、配置不合理或利用不充分等问题,运用卫生经济学评价方法对于评估艾滋病防治措施的效率、资源配置的合理性和利用的有效性具有重要意义。本文对我国近年来卫生经济学评价方法在艾滋病防控领域的应用进行回顾性描述和总结,建议建立健全符合我国实际的艾滋病防控的卫生经济学评价体系。     

乌鲁木齐市2002～2009年结核病控制项目卫生经济学评价

目的分析评价乌鲁木齐市实施结核病控制项目的成本-效用成本-效果及社会效益和经济效益,为卫生资源投入与使用提供科学依据。方法收集2002～2009年结核病控制项目季报、年报及人口学资料,进行成本-效果、成本-效用、成本-效益分析。结果 8年间政府及相关国际组织投入经费667.8万元,共治愈病人3 362例,每发现并治疗一例患者费用为999.1元,挽回DALY 35 432年,共获得496个完整生命。减少新肺结核病人1 681～2 522例,间接避免了新发病例DALY损失17 716～26 579年。挽回GDP损失约23.48亿元,避免了因病造成的个人收入损失累计达7.26亿元。结论 8年来乌鲁木齐市结核病控制项目取得效果明显,为保障人民群众身体健康做出了积极贡献。     

贵州省农村癫痫项目点防治管理的成本-效用分析

目的 了解贵州省内农村癫痫项目覆盖地区参与管理治疗和自行治疗的癫痫患者在治疗后,费用和生存质量改善方面的情况,为管理治疗癫痫的后期成本投入提供科学依据。方法 采用QOLIE-31量表收集2组癫痫患者的生存质量情况,并计算改善的QALY值,依据卫生经济学的分析方法,计算其成本效用。结果 经比较,项目组与非项目组的各项指标均无统计学差异,具有较好的比较性。项目组平均QALY为30.14,非项目组为17.62,QALY的改善主要集中在中青年癫痫患者;项目组平均改善1个QALY需要20 903.8元,非项目组为24 201.4元,项目组人均成本效用比为34.10,而非项目组为136.73。结论 农村癫痫防治管理项目在提高农村癫痫患者的生存质量方面具有经济优势,作为一项惠民政策,应该逐步推广综合干预模式,为其他农村综合防治项目提供参考。     

卫生经济成本效果分析的前沿评价方法研究

健康与卫生保健是卫生领域里最受关注的经济和政治问题。由于卫生经济学涉及公共政策的制定和实施,所以,我们必须系统地评价可供选择的政策方案。通过对国内外相关文献中3种经济评价方法的阐述,着重介绍和分析了成衣效用分析法,并认为该方法在现阶段的中国更具有实际应用价值。     

农村癫痫病控制技术的临床效果及卫生经济学评价

目的：通过对农村癫痫病控制技术的全面系统评价,探讨适合我国农村地区癫痫病控制技术。方法：采用对比分析的方法,将单纯使用苯巴比妥药物治疗癫痫的患者与丙戊酸镁、苯巴比妥、拉莫三嗪混合治疗癫痫患者的效果和成本进行比较分析。结果：两者在治疗癫痫的效果上差异无统计学意义,但通过成本效果、成本效用分析,发现前者的比值均明显小于后者。结论与建议：使用苯巴比妥药物治疗癫痫的方法在疗效上虽不具有优势,但成本优势明显且痛苦小,适合在农村地区推广应用。     

肺癌筛查的卫生经济学评价研究

目的:对肺癌筛查进行成本一效果分析,评价肺癌筛查的经济性。方法:构建肺癌筛查决策树模型,对肺癌筛查及不筛查两种策略进行投入产出分析,评价两种策略的成本与健康产出,并进行增量成本一效果分析,判断肺癌筛查策略的经济性。结果:肺癌筛查策略与不筛查策略相比,每多获得1个寿命年的成本为93 153元。结论:根据WHO推荐阈值,在人群中实施肺癌筛查是具有成本一效果的,应在人群中积极推广肺癌筛查。     

第一讲 经济学评价概述(二)

二、成本效果分析 因为成本效果分析具有相对简单的特点,所以,它能成为卫生保健经济学评价的最常见的形式。应用成本效果分析并不要求用货币形式来评价效益。成本效果分析处理技术效率问题,它寻求回答以下问题:如果已知要达到的目标,那么,实现该目标最好的途径是什么,     

湖北省农村癫痫防治管理项目效果评价

目的通过分析湖北省农村癫痫防治管理6个项目县(市)的随访管理资料,评价苯巴比妥的治疗效果。方法按照国家癫痫项目办农村癫痫防治管理项目工作手册(2013年)的要求,在湖北省6个县(市)开展农村癫痫患者筛查、诊断复核、药物治疗、病例随访和治疗质控的效果评价。2014年12月~2016年12月,6个项目县(市)共管理服用苯巴比妥治疗的患者1 649例。疗效评估以癫痫发作次数的变化作为判定标准。结果 1 649例苯巴比妥治疗的患者中,1 358例患者随访管理满12个月,其中显效患者1 019例(患者未发作或发作减少75.00%以上),占75.04%;746例患者随访管理满24个月,其中显效患者533例,占71.45%。有效控制癫痫发作的病例中,有73.01%的患者服用苯巴比妥日平均剂量在60~119 mg。共有56例患者出现1项中度或重度不良反应。退组原因排名前3位的是好转、依从性不好和迁出。疾病、原因不明和溺水是主要的死亡原因。结论湖北省农村癫痫防治管理项目的实施有效地控制了农村癫痫患者的发作,适合在农村贫困地区广泛应用。     

两种常用EQ-5D量表效用值积分体系的比较及其对成本效用分析结果的影响探讨

我国尚没有开发基于我国人群偏好的EQ-5D量表效用值积分体系,目前采用该量表进行的成本效用分析大多是以英国及日本的积分体系计算健康状态效用值。文章通过分析这两种体系对量表中所有状态的预测效用值发现,相比日本的结果,采用英国积分体系所得的效用值较低,且当其用于成本效用分析时更倾向于接受成本较高效用值也较高的治疗方案。研究人员在比较不同研究结果时应充分关注因使用不同积分体系而产生的差异,同时认为鉴于该体系与各国文化背景紧密相连,应尽早开发适合我国人群的EQ-5D量表效用值积分体系。     

A note on the nature of utility in time and health and implications for cost utility analysis

Time Trade-Off (TTO) valuations of health are widely used in economic evaluation of health care. Current approaches to eliciting TTO values, and their use in economic evaluation, rest on specific assumptions about the way utility relates to time and health. Both the assumptions themselves and evidence of violations of them are discussed in the literature – yet the issues appear not to be widely appreciated by those using and applying TTO in economic evaluation. This paper adds to that literature by demonstrating both the requirements of TTO and violations of these assumptions in terms of the underlying indifference curve maps and utility functions. The advantage of this approach is that it demonstrates very clearly a number of fundamental problems for the way TTO values are currently elicited and used in cost utility analysis. In essence, it is extremely unwise to assume that the current ‘tariffs’ of TTO values, such as those widely used in cost utility analysis to inform health sector decisions in many countries can be applied irrespective of the duration of the health states to which they are assigned. The estimates of QALYs that result will, quite often, simply be wrong. We conclude by pointing to a number of possible solutions.     

奥曲肽治疗急性胰腺炎疗效和经济学的评价

目的：评价奥曲肽治疗急性胰腺炎的临床疗效和经济性。方法：回顾性调查本院收治的急性胰腺炎患者１１８例，其中水肿型胰腺炎（ＡＥＰ）８２例，重症胰腺炎（ＳＡＰ）３６例。根据入院时的病情分组，奥曲肽组（ＡＥＰ４１例，ＳＡＰ２１例）是在常规治疗的基础上加用奥曲肽０．１ｍｇ，Ｑ８ｈ，皮下注射或以２５μｇ／ｈ微泵静脉输注，对照组为常规治疗组。统计两组临床疗效指标，同时计算其经济学的项目费用，并采用成本效果比为评价指标。结果：临床疗效除重症患者的腹痛缓解天数治疗组明显小于对照组外（Ｐ＜０．０５），其它各项指标均无显著性的差异，但是治疗组的费用远高于对照组。结论：加用奥曲肽治疗急性胰腺炎的疗效还有争议，从经济学的角度看并不具有成本效果。     

上海市金山区农村癫痫患病率调查

目的　调查上海市金山区农村癫痫患病率、药物治疗现状及癫痫患者的就业、教育、家庭、婚姻等社会心理状况 ,以便制订癫痫综合防治方案。方法　 2 0 0 0年在金山区朱泾镇采用分层整群抽样原则完成 5万人群的癫痫普查。结果　癫痫粗患病率为 3.11‰ ,标化患病率为 3.6 2‰ ,其中男性3.6 5‰ ,女性 2 .5 0‰ ,男性皆明显高于女性 (χ2 =4 .79,P <0 .0 1) ;农村患病率为 3.70‰ ,明显高于城镇2 .4 5‰ ;年龄组患病率分布有两个高峰 ,第一高峰表现在 10～ 30岁 ,第二高峰表现在 6 0岁年龄组。结论　金山区居民癫痫患病率在国内处于中等偏低水平。     

Assessment of clinical and economic benefits of weight management with sibutramine in general practice in Germany

Obesity is associated with major health risks and a high economic burden impacting on health care systems. This study utilises the latest evidence from randomised clinical trials (RCTs) to explore and to assess the cost effectiveness of sibutramine in combination with diet and lifestyle advice compared to diet and lifestyle advice alone for the treatment of obese subjects without comorbidities at baseline in Germany. New evidence from recently published RCTs and post-marketing surveillance studies, including health economic data as well as quality of life (QoL) data, were used to model the long-term outcomes of weight management with sibutramine in German practice. German healthcare costs and new data from over 8,000 patients were analysed based on a recently published model. These new RCT data were used to model weight losses, proportion of responders to treatment, utilities by weight loss and variability in weight regain post-treatment. Costs and QoL benefits associated with weight loss (using SF-36 data from sibutramine trials), reduced incidence of coronary heart disease (using Framingham equations) and diabetes were used to estimate the cost per quality adjusted life year of sibutramine treatment. For 1,000 patients treated with sibutramine for 1 year, extrapolating outcomes over 4 further years, sibutramine is estimated to save 4.18 CHD events, 2.58 diabetes incident cases and give 51.5 more quality-adjusted life years (QALYs). The cost-utility analysis (CUA) estimates €13,706 per QALY gained. Results are sensitive to changes in weight loss, rate of weight regain and discounting rate. Although the non-pharmacological weight management programme in the comparator arm yielded higher weight losses than generally observed in clinical practice, these results demonstrate that additional sibutramine treatment is a cost effective therapy for an obese population without comorbidities in Germany. The CUA results are within the range generally accepted as cost effective and should be viewed as conservative when generalizing to settings offering standard non-pharmacological treatment.     

Social integration of children with epilepsy in rural India

Only a small fraction of people with epilepsy in developing countries has access to medical facilities. Even with effective treatment, their psychosocial needs are often overlooked in the absence of obvious disability. In rural areas, community-based rehabilitation programmes assist in the integration of people with disabilities into employment and the community. However, the functional impairment associated with epilepsy is not well recognised in intervention programmes in developing countries. We report, for the first time, the social activities of children with epilepsy and their peers in rural India. We employed a cross-sectional design using a new age and sex-specific social activity questionnaire. Population screening in the context of a community-based rehabilitation programme identified 88 children with epilepsy and 250 randomly selected controls. A trained interviewer administered the questionnaire to mothers in Bengali. Girls' activities were principally domestic, whilst boys' were mostly outdoors and involved peers. All groups of children with epilepsy had significant social deficits, equally for boys and girls in the age range from 2 to 18 years (p < 0.05). Boys with epilepsy had limited peer group activities, and parents conferred fewer responsibilities to school age and adolescent children compared to controls. The nature and degree of deficits were beyond the constraints imposed by neurological impairment. Our findings in pre-schoolers were consistent with parental attitudes of overprotection found in previous research. We conclude that social integration needs active and early promotion among children with epilepsy. The assessment of remediable risk and protective factors in the family and community is an important practical area for research in community-based rehabilitation.     

健康教育对成年癫痫患者治疗依从性及生活质量的影响

目的探讨健康教育对成年癫痫患者治疗依从性及生活质量的影响。方法将130例成年癫痫患者分为健康教育组（68例）和非健康教育组（62例）,均给予规范化治疗,健康教育组对患者及家属普及癫痫相关知识及个别心理咨询,随访时间为6个月,采用成年癫痫患者生活质量量表-31（QOLIE-31）中文版进行评定。结果健康教育组患者及家属癫痫相关知识知晓率（94．12％）明显高于非健康教育组（29．03％）（χ^2=58．99,P〈0．05）;研究期间不规范用约（10．29％）及调整用药人次（27．94％）明显低于非健康教育组（27．42％,45．16％）（均P〈0．05）;3个月及6个月时发作频率减少50％以上者（79．41％,85．29％）及完全控制者（36．77％,42．65％）明显高于非健康教育组（51．61％,61．29％,20．97％,25．81％）（均P〈0．05）。研究结束时,两组患者QOL总分及各分项得分均较研究前有提高（均P〈0．05）,其中健康教育组提高程度史为显著（均P〈0．05）。结论开展健康教育有助于提高癫痫患者治疗依从性,减少发作,提高生活质量。     

湖北省结核病世行贷款控制项目经济学评价

目的 运用成本-效果、成本-效益方法对湖北省结核病控制项目进行卫生经济学评价，为推行DOTS结核病控制策略，加强结核病控制的经济支持能力提供依据。方法 根据湖北省世行项目结核病人控制费用调查表及卫生经济与评价方法。结果 初治病人每l元的投入最高可获得14．87元的收益；项目每多投入l万元，可多发现初治涂阳病人12人；与初治病人比较，复治病人治疗成本高，效果差，经济负担重。结论 结核病世行控制项目具有较高的经济效率，鉴于结核病人疾病负担重，且多发于贫困人群，建议继续推行DOTS策略。