某省DOTS策略实施的流行病学与卫生经济学效果评价

目的 :评价河南省直接督导下短程治疗 (DOTS策略 )实施效果。方法 :以 1990年结核病疫情 (DOTS策略实施前 )为基线 ,根据 DOTS、非 DOTS地区 2 0 0 0年肺结核患病率抽样调查情况 ,分别从流行病学与卫生经济学角度评价DOTS策略的实施效果。结果 :2 0 0 0年 DOTS地区的活动性、菌阳、涂阳、空洞肺结核患病率与 1990年相比 ,分别下降了15 .6 %、 3.0 3%、 2 6 .32 %、 5 9.0 6 % ,年递降率分别为 1.6 8%、 0 .2 8%、 3.0 4 %、 8.5 7% ;非 DOTS地区 2 0 0 0年活动性、空洞肺结核患病率与 1990年相比 ,分别下降了 2 .91%、 19.5 9% ,年递降率分别为 0 .2 9%、 2 .15 % ,而菌阳、涂阳肺结核患病率分别上升了 3.6 3%、 7.36 % ,年递增率为 0 .37%、 0 .73% ;DOTS策略的实施平均每减少一例死亡的费用为 1816元 ,平均每减少一个 PYL L的费用为 14 0元 ,成本效益比为 1/ 15 .6。结论 :河南省 DOTS策略的实施显著降低了 DOTS覆盖地区的结核病疫情 ,是个成本效益好的卫生干预措施

EVALUATION ON IMPLEMENTARY EFFECT OF DOTS IN HENAN FROM THE VIEWPOINT OF EPIDEMIOLOGY AND HEALTH ECONOMICS

Objective:To evaluate implementary effect of DOTS in Henan.Method:Comparing with the tuberculosis prevalence in 1990(before implementing DOTS) and the tuberculosis prevalence changing trend in non-DOTS-covering area from 1990 to 2000,the implementary effect of DOTS in Henan was evaluated from the viewpoint of epidemioloy and health economics.Result:In comparison with 1990,the prevalence of active pulmonary tuberculosis,the prevalence of bacteriology positive pulmonary tuberculosis,the prevalence of smear positive pulmonary tuberculosis,the prevalence of cavity pulmonary tuberculosis decreased 15.6%,3.03%,26.32%,59.06% respectively,and their annual reduction rates were 1.68%,0.28%,3.04%,8.57% respectively in DOTS-covering area in 2000;compared with 1990,the prevalence of active pulmonary tuberculosis,the prevalence of cavity pulmonary tuberculosis decreased 2.90% and 19.59% and their annual reduction rates were 0.29% and 2.15% in non-DOTS-covering area but the prevalence of bacteriology positive pulmonary tuberculosis,the prevalence of smear positive pulmonary tuberculosis increased 3.63% and 7.36% in non-DOTS-covering area.It cost 1 816 yuan and 140 yuan averagely for DOTS to reduce one death and one PYLL respectively,and its cost benefit rate was 1/15.6.Conclusion:It reduced the pulmonary tuberculosis prevalence rate significantly to implement DOTS in Henan and it was a cost-benefit health intervention measure.