部队甲肝疫苗接种策略的成本-效用分析

目的：探讨部队甲肝疫苗接种的最佳策略，为部队甲肝预防提供依据。方法：以质量调整生命年（Quality-adjusted life year,QALY)为效用指标进行成本效用分析。结果：在现有的卫生经济条件下，采用先筛选后接种方案（Screen-Vaccination,SV)的接种甲肝疫苗的成本效用比（Cost-utility ratio,CUR)，干部为-140.37元/QALY，新兵为2661.04元/QALY，明显低于直接接种方案（Direct-Vaccination,DV)的CUR，干部为8044.05元/QALY，新兵为9142.96元/QALY），且干部CUR值小于新兵，因此部队接种甲肝疫苗应首选SV方案并优先接种干部人群，灵敏度分析表明，疫苗保护期，筛选实验费，疫苗保护率等是影响决策方案CUR的主要因素，但除疫苗保护期外，决策结果不随各参数的波动而发生根本变化。结论：在目前状况下，部队接种甲肝疫苗宜首选SV方案，优先接种干部人群。

COST-UTILITY ANALYSIS OF VACCINATION AGAINST HAV INFECTION IN THE MILITARY

Obiective: To determine the most cost-effective vaccination strategy against HAV infection in the military. Methods: Cost-utility analysis was performed by using quality-adjusted life year ( QALY) as the index of utility. Results: The decision analysis indicated that CUR (Cost-utility ratio) of the screen before vaccination(SV)strategies against Hepatitis A (for officers:$-140.37/QALY, for recruits $2 661.04/QALY) were lower than those of the direct vaccination (DV) strategies ($8 044.05/QALY and $9 142.96/QALY respectively) and CUR for the officers was lower than that of the recruits, so vaccinating against hepatitis A in the military should be given priority to the officers in SV strategy. The sensitivity analysis showed that protection duration of the vaccine, screen cost, protection rate of vaccine were the main factors affecting CUR but the result of decision analysis was fairly insensitive to the fluctuation of the input parameters except the protection duration of vaccine. Conclusion: The officers in the military should be taken as the favorable population for HAV vaccination using SV strategy in the light of cost-utility.