西安市社会医疗保险参保人群接种流感疫苗的成本效益分析

Cost-benefit analysis on the strategy of social health insurance regarding vaccination against influenza in Xi＇ an city

目的评价西安市参保职工接种流感疫苗的成本效益。方法选择西安东方集团有限公司为研究现场，对该集团公司全部12109名参保职工，用随机整群抽样方法，抽取2949人，进行问卷调查。样本人群中，接种流感疫苗1900人、未接种流感疫苗1049人。采用历史性队列研究方法，对接种组和对照组同时进行回顾性调查。重点调查流感疫苗接种后12个月内，两组人群呼吸系统、心脑血管疾病及其他慢性病患病情况及医疗服务利用情况。结果接种组呼吸系统疾病和心脑血管疾病粗住院率分别为0．51％和1．64％，较对照组降低了68．90％和56．05％。疫苗接种后第3、4个月接种组和对照组粗住院率分别为0．62％、0.80％和0．28％、1．00％。65岁及以上年龄接种组粗住院率较对照组低53．59％。2005年度西安市参保人群接种流感疫苗降低住院率产生的效益成本比标化后为6．48。结论西安市参保职工接种流感疫苗具有较高的成本效益，产生良好成本效益的原因是，明显降低了接种组参保中老年职工呼吸系统和心脑血管疾病住院率。

Objective To assess the economic implications of an annual vaccination strategy against influenza among people who were on a social-health program. Methods A retrospective cohort study was conducted. 1900 persons who had received the influenza vaccine were served as vaccine group, while 1049 persons who did not receive the vaccine were served as controls. Cluster random sampling method was used. Both of these two groups came from Donfang Company in which there were 12 109 employers in total and all of them joined the social health insurance program. The survey was carried out when the influenza vaccine was given one year ago. Results The rates of vaccine group and control group for respiratory system diseases and cardiovascular diseases who were hospitalized, were 0.51%, 2.47% and 1.64%, 5.62% which showed 68.90 % and 56.05 % decrease, when compared with the control group. The crude inpatient rate among vaccinees and control group after receiving the vaccination for three and four month were 0.62 % ,0.80 % and 0.28 % , 1.00 % respectively. The inpatient rate of oldest-age group decreased by 53.59 % , compared with control group. The cost-benefit ratio generated by the use of influenza vaccine in reducing the hospitalization rate was 6.48：1 for Social Health Insurants in Xi＇ an city. Conclusion The Strategy to vaccinate the social-health-insured residents on influenza in Xi＇ an city had gained better economic benefits in reducing the hospitalization rate of respiratory system diseases and cardiovascular diseases for mild and old-aged persons.