基于决策树-马尔科夫模型的麻疹疫苗接种经济学评价
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摘要
目的评估麻疹疫苗接种的成本-效益和成本-效果。方法建立决策树-马尔科夫模型,以麻疹疫苗接种为研究策略,不接种为对照策略,以2014年浙江省出生人口数为队列人群,估计不同策略的长期成本和健康效果。采用净效益(NPV)、效益成本比(BCR)和增量成本效果比(ICER)进行策略间比较。通过敏感性分析评价各个参数的不确定性。结果实施麻疹疫苗接种策略需投入1602.37万元。成本效益分析结果显示,以麻疹总体经济负担计算,在模拟期限内麻疹疫苗接种可获得137813.08万元的净效益,BCR为7.06。成本效果分析结果显示,接种麻疹疫苗可避免186534例麻疹病例及3404例麻疹死亡病例,每投入85.90元可避免一例麻疹病例,每投入4707.31元可避免一例麻疹死亡。敏感性分析显示麻疫苗接种率和保护率是影响BCR的最主要因素。结论麻疹疫苗接种显示较高成本效益和成本效果价值,是一项经济有效的公共卫生干预措施。
引文
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[2] 吴霆.中国防制麻疹的历史和现状.中华流行病学杂志,2000(2):63-66.
[3] 国家卫生和计划生育委员会.2006中国卫生和计划生育统计年鉴.北京:中国协和医科大学出版社,2006.
[4] 国家卫生和计划生育委员会.2016中国卫生和计划生育统计年鉴.北京:中国协和医科大学出版社,2016.
[5] 陈俊泽,曾雁冰,方亚.疫苗经济学评价中的数学模型研究进展.中国卫生统计,2016(6):1092-1096.
[6] 时松和,李桑桑,刘德臣,等.脑卒中三级网络筛查及对早期干预方案的卫生经济学分析.中国卫生统计,2017(3):459-461.
[7] 朱玫烨,薛佳殷,李萍,等.胃癌高危人群胃镜监测策略的卫生经济学评价.中国卫生统计,2017(3):462-464.
[8] 陈海,陈洁玲,陆志刚,等.基于Markov模型建立慢性丙肝治疗的药物经济学模型.中国卫生统计,2016,33(3):370-373.
[9] Hoshi S L,Kondo M,Okubo I.Economic evaluation of vaccination programme of mumps vaccine to the birth cohort in Japan.Vaccine,2014,32(33):4189-4197.
[10] 杨品超,张顺祥,孙盼盼,等.乙型肝炎防治经济学评价——马尔科夫模型的构建.中华流行病学杂志,2017(7):845-851.
[11] Thompson K M,Odahowski C L.Systematic Review of Health Economic Analyses of Measles and Rubella Immunization Interventions.Risk Anal,2016,36(7):1297-1314.
[12] 李永秋,张英洁.山东省免疫规划时期麻疹免疫预防工作的卫生经济学评价.现代预防医学,2017(1):106-109.
[13] 梁飞琼,何炳欣,黄劲梅,等.麻疹疫苗强化免疫策略的成本效益分析.职业与健康,2011(13):1546-1547.
[14] 胡奇胆,刘千晓,高钟武.莆田市消除麻疹免疫策略成本-效益分析.海峡预防医学杂志,2017(4):86-88.
[15] 王倩,金丕焕.Markov模型在卫生经济评价的应用.中国卫生统计,2000,17(2):86-88.
[16] 李振鹏,李晓毅,张大为,等.传染病的Markov过程模型研究.中国卫生统计,2008(5):497-499.
[17] 浙江省统计局国家统计局浙江调查总队.浙江统计年鉴-2015.北京:中国统计出版社,2015.
[18] Zhou.F,Reef.S,Massoudi.M,et al.An Economic Analysis of the Current Universal 2-Dose Measles-Mumps-Rubella Vaccination Program in the United States.The Journal of Infectious Diseases,2004,189:S131-45.
[19] 桂裕亮,韩晟,翁鸿,等.应用TreeAge Pro软件实现基于Markov模型的成本-效果分析.中国循证医学杂志,2018(1):116-120.
[20] Dayan G H,Cairns L,Sangrujee N,et al.Cost-effectiveness of three different vaccination strategies against measles in Zambian children.Vaccine,2004,22(3-4):475-484.
[21] Li Q,Hu Y,Zhong Y,et al.Using the Immunization Information System to determine vaccination coverage rates among children aged 1-7 years:a report from Zhejiang Province,China.Int J Environ Res Public Health,2014,11(3):2713-2728.
[22] CDC.Morbidity and Mortality Weekly Report.USA:1991.
[23] CDC.Complications of measles.(2017-03-03)[11-15].https://www.cdc.gov/measles/about/complications.html.
[24] Filia A,Brenna A,Pana A,et al.Health burden and economic impact of measles-related hospitalizations in Italy in 2002-2003.BMC Public Health,2007,7:169.
[25] Beutels P,Van Damme P,Van Casteren V,et al.The difficult quest for data on "vanishing" vaccine-preventable infections in Europe:the case of measles in Flanders(Belgium).Vaccine,2002,20(29-30):3551-3559.
[26] Perry RT,Halsey NA.The clinical significance of measles:a review.J Infect Dis,2004,189 Suppl 1:S4-S16.
[27] Nath A,Berger JR.Clinical Neurovirology.New York:Macrel Dekker,2003.
[28] Miller HG,Stanton JB,Gibbons JL.Acute disseminated encephalomyelitis and related syndromes..Br Med J,1957,5020(1):668-672.
[29] CDC.Epidemiology and Prevention of Vaccine-Preventable Diseases.Washington DC:Public Health Foundation,2009.
[30] Walker D G,Hutubessy R,Beutels P.WHO Guide for standardisation of economic evaluations of immunization programmes.Vaccine,2010,28(11):2356-2359.
[31] 符剑,何寒青,赵艳荣,等.浙江省不同时期麻疹减毒活疫苗应用效果的卫生经济学研究.中国疫苗和免疫,2011(04):333-335.
[32] 郑金凤,潘伟毅,蔡志坤,等.福建省消除麻疹免疫策略实施的成本-效益分析.海峡预防医学杂志,2006(1):8-10.
[33] Takahashi K,Ohkusa Y,Kim J Y.The economic disease burden of measles in Japan and a benefit cost analysis of vaccination,a retrospective study.BMC Health Serv Res,2011,11:254.
[34] 关静.新疆麻疹强化免疫的经济与社会效益分析.新疆医科大学,2007.
[35] Canfell K,Chesson H,Kulasingam S L,et al.Modeling preventative strategies against human papillomavirus-related disease in developed countries.Vaccine,2012,30(Suppl 5):F157-F167.