目的:这项研究的目的是评估1994年至2001年出生的儿童(8-15岁)的乙肝疫苗接种追赶计划的长期成本效益。中国,为全国评估和未来政策制定提供信息。
方法:我们确定了追赶计划与现状(无追赶计划)相比的成本效益。我们结合了决策树模型和马尔可夫模型来模拟乙肝病毒(HBV)感染后的疫苗接种和临床进展。模型中的参数来自文献,实地调查,程序文件,和国家法定疾病报告系统(NNDRS)。增量成本效益比(ICER)用于比较两种替代策略。单向敏感性分析,双向敏感性分析,和概率敏感性分析用于评估参数不确定性。
结果:与现状相比,追赶计划占主导地位。共使用553万剂疫苗,追赶计划可以预防21,865例有症状的急性乙型肝炎,3,088个携带者状态,乙型肝炎表面抗原(HBsAg)阳性,和812例由于HBV感染而死亡。追赶计划可以增加28,888个质量调整生命年(QALYs),并在未来为目标人群节省1.9201亿美元。模型很健壮,考虑参数不确定性。
结论:山东省在1994年至2001年出生的儿童中实施的追赶计划非常节省成本。它可以节省生命年,并降低未来的总成本。我们的研究支持了这种追赶计划在整个中国的可取性和影响。
OBJECTIVE: The aim of the study was to estimate long-term cost‑effectiveness of a hepatitis B vaccination catch-up program among children born between 1994 and 2001 (when they were 8‑15 y old) in Shandong province, China, to provide information for nationwide evaluation and future policy making.
METHODS: We determined the cost-effectiveness of the catch-up program compared with the status quo (no catch-up program). We combined a Decision Tree model and a Markov model to simulate vaccination and clinical progression after hepatitis B virus (HBV) infection. Parameters in the models were from the literature, a field survey, program files, and the National Notifiable Disease Reporting System (NNDRS). The incremental cost‑effectiveness ratio (ICER) was used to compare the 2 alternative strategies. One-way sensitivity analysis, 2-way sensitivity analysis, and probability sensitivity analysis were used to assess parameter uncertainties.
RESULTS: The catch-up program was dominant compared with the status quo. Using a total of 5.53 million doses of vaccines, the catch-up program could prevent 21,865 cases of symptomatic acute hepatitis B, 3,088 carrier states with positive hepatitis B surface antigen (HBsAg), and 812 deaths due to HBV infection. The catch-up program could add 28,888 quality-adjusted life years (QALYs) and save $192.01 million in the targeted population in the future. The models were robust, considering parameter uncertainties.
CONCLUSIONS: The catch-up program in Shandong province among children born between 1994 and 2001 was \'very cost-saving.\' It could save life years and reduce total future costs. Our study supported the desirability and impact of such a catch-up program throughout China.