阻断艾滋病病毒母婴传播的成本效果分析

Study on the cost of preventing AIDS transmission from mothers to children-an effect analysis

目的对艾滋病高发区某试点省的母婴HIV阻断措施进行经济学评价，探讨其成本效果和该措施的经济学效率。方法根据阻断人数和各项阻断措施的费用计算成本，计算避免1例感染HIV的费用，避免1个伤残（失能）调整生命年（DALY）损失的费用，阻断1例感染HIV的费用与1例感染HIV后的经济损失对比，计算当成本与效果均等时的孕妇HIV阳性率。结果终止妊娠措施成本效果：每避免1 DALY损失的费用平均为2264元；避免1例感染的费用平均46963元，感染后平均每例经济损失为211000元，效果成本比值为4．5：1。综合措施成本效果：避免1例感染成本为60853元，避免1 DALY损失的成本为2937元，效果成本比值为3．5：1。结论阻断HIV母婴传播的成本效果显著，当孕妇HIV阳性率〉0．03％时进行筛查和母婴传播阻断均具成本效果价值，是对有限资源的有效利用。

Objective To evaluate the costs of preventing AIDS transmission from mothers to children in a high-incidence area and to investigate relations between costs and effects, as well as to study the economical effects of this approach. Methods According to the number of patients and each strategy on prevention of AIDS transmission, following aspects were calculated as： the cost of preventing each patient with HIV infection, to avoid the cost of one disability adjusted life year （DALY）, to evaluate the cost of each patient with either HIV infection or HIV-infected thereafter,and to calculate the HIV-positive rates in mothers at the same levels between costs and effects. Results The costs-effects for stopping pregnancy： it was 2264 Yuan for preventing one DALY, the costs of avoiding one case with HIV infection was 46 963 Yuan,but it was 211 000 Yuan from each patient after HIV infection, the ratio between effects and costs was 4.5：1. The costs-effects for comprehensive strategies showed that the cost was 60 853 Yuan for avoiding one case with HIV infection. It was 211 000 Yuan for each patient after HIV infection and the ratio between effects and costs was 3.5：1. Conclusion The cost-effect of preventing HIV transmission from mothers to children was significant on the basis of economical level. It was more effective to evaluate the relation between costs and effects according to economical level in sereening and preventing transmission from mothers to children under the situation that the HIV-positive rate in pregnant mothers was more than 0.03%.