上海市新生儿乙型肝炎疫苗接种成本效果、效益与效用分析

目的 研究上海市1992～2001年新生儿乙型肝炎(乙肝)疫苗接种的成本效果、效益与效用。方法 运用项目成本测算方法计算乙肝疫苗接种成本;估计接种乙肝疫苗后减少人群携带HBsAg人数与慢性乙肝、肝硬化、肝癌患者人数为直接效果指标;运用调查表形式调查乙肝、肝硬化和肝癌患者患病时间与治疗费用;专家访谈了解乙肝患者的治疗与病程;运用成本效益分析方法计算乙肝疫苗接种的成本效益;运用失能调整生命年计算其疾病负担作为效用指标。结果 乙肝疫苗接种成本投入501 129.49元将会减少1例肝癌发生,10例肝硬化发生,100例慢性乙肝患者发生,1000例HBsAg阳性率携带者;上海市新生儿乙肝疫苗免疫接种10年总成本为0.24亿元,获得总效益为41.22亿元,成本效益比是1:172元;估计挽回乙肝、肝硬化、肝癌的疾病总负担为59 762.55个失能调整寿命年(DALY),挽回1个DALY的成本为402.50元。结论 新生儿乙肝疫苗接种是一种低成本投入高效果产出策略。

Study on the cost-effectiveness,benefit and utility analysis on the infant inoculation hepatitis B vaccine in Shanghai

Objective To study the cost-effectiveness, benefit and utility of infant hepatitis Bvaccination in Shanghai from 1992 to 2001. Methods To calculate the cost of hapatitis B vaccination bycost analysis method. Both the numbers of persons with HBsAg positive and patient with hepatitis B,cirrhosis and liver cancer decreased as the index of direct effect. To study the sick-time and the cost oftreating hepatitis B, cirrhosis and liver cancer patients, a face to face questionnaire was used and quasimethod was adopted to underestand the effect of cure and the course of hepatitis B. The cost benefit analysismethod was also used to calculate the cost benefit of HBV vaccine. The disability adjusted life years(DALY) was regarded as an index of utility to measure the disease burden. Results Input of 501 129. 49Yuan might have the result of reducing one liver cancer patient, ten cirrhosis patients, one hundred chronichepatitis B petients and one thousand HBsAg positive people. The cost of hepatitis B vaccination was 0. 24hundred million Yuan during the past ten years in Shanghai, which had obtained the total benefit value of41. 22 hundred million Yuan, with a cost benefit ratio of 1: 172 Yuan. It was estimated tha the totaldisease burden of hepatitis B, cirrhosis and liver cancer patients was 59 762. 55 DALY in order to reduceone DALY loss cost of 402. 50 Yuan. Conclusion HBV vaccine inoculation in infants seemed to be a lowcost input and high-effect output strategy.