南昌市阻断母婴HBV传播综合措施的卫生经济学分析

目的　探讨南昌市阻断母婴HBV传播的综合干预措施及其卫生经济学效果。方法　将128例大三阳、49例小三阳的孕妇及其婴幼儿分两组，分别采取方案一和方案二进行免疫阻断。采新生儿脐血检测宫内感染情况，待1周岁时检测静脉血HBV血清标志比较免疫阻断效果。将免疫阻断有效的119例大三阳、48例小三阳的孕妇及其婴幼儿分为两组：干预组无母乳喂养，并给予健康教育、维护抗－HBs抗体水平；对照组进行母乳喂养且不做行为干预。3周岁时检测静脉血HBV血清标志。运用成本－效益分析方法，以2005年南昌市预计HBV感染母亲及新生儿作为成本研究对象，该年乙肝罹患率／新发现的乙肝患者作为效益研究的对象，计算实施干预措施后的成本效益比（BCR）。结果　采用不同免疫阻断方案的大三阳孕妇宫内感染率间差异有统计学意义（P〈0．05）；免疫阻断率间差异无统计学意义（P〉0．05）。3周岁时检测HBV血清标志：干预组HBsAg无阳转；对照组有1例HBsAg阳转。2005年在南昌市实施阻断母婴HBV传播的综合措施，估计在出生的孕母为HBV感染者的产儿5347例中，可减少HBsAg阳性2139人、急性乙肝患者214人、慢性乙肝患者214人、肝硬化21人和肝癌2人。采取干预措施后的总效益为9843720元、总成本为3566448元，BCR为2．76。结论　综合干预措施可降低HBV宫内感染率，提高和巩固免疫阻断效果，提高人口素质，产生的社会效益和经济效益可观。

Health Economics Analysis of Comprehensive Intervention in Blocking the Mother-to-Child Transmission of HBV

Objective To explore the effect of comprehensive intervention in blocking the mother-to-child transmission of hepatitis B virus(HBV)and its health economic results.Methods Totally 128 cases of hepatitis B surface antigen(HBsAg),hepatitis B e-antigen(HBeAg)and antibody to hepatitis B core antigen(HBcAb)-positive and 49 cases of HBsAg,antibody to hepatitis B e-antigen(HBeAb)and HBcAb-positive mothers and their children were divided into two groups,who were respectively given two different blocking ways of Hepatitis B immune globulin(HBIG)and hepatitis B Vaccine.The umbilical cord blood of newborn in cord was sampled to observe the intrauterine infection;and as the infants grew to be one year HBV level in venous blood was tested to compare the immune blocking effects.After that,167 cases with effected immune blocking were divided into two groups:intervention group receiving no breastfeeding,but health education and maintenance of antibody to HBsAg;control group receiving breastfeeding,but with no behavior intervention.The serological markers of HBV were detected in the venous blood of the babies when they were three years old.A cost-benefit analysis was conducted.The expected mothers and their newborns infected with HBV in Nanchang in 2005 were taken as the cost study subjects,and the newly discovered hepatitis B patients as benefit study subjects;the cost-benefit ratio after practiced the interventions was calculated.Results There was significant difference in HBV's intrauterine infection rate between two different immune blocking ways in the pregnant women with positive HBsAg,HBeAg and HBcAb(P<0.05),but no significant difference in rate of immune blocking(P>0.05).In serological markers of HBV detected in the veins blood of the three-year-old babies:there is no case of positive HBsAg in the intervention group,while tone case of positive HBsAg in the control Group.It is expected that,in the 5347 babies whose mother was infected with HBV,the reduced cases with positive HBsAg,acute hepatitis B,chronic hepatitis B,hepatic cirrhosis and hepatic cancer could respectively be 2139,214,214,21 and 2 as the result of conducting the comprehensive intervention of blocking the Mother-to-child transmission of HBV in Nanchang in 2005.The total benefit was 9 843 720 RMB yuan,the total cost was 3 566 448 RMB yuan and the BCR is 2.76.Conclusion The comprehensive intervention can lower the HBV,intrauterine infection,enhance and consolidate the effects of immune blocking,improve the quality of population and produce social and economic benefits greatly.