结核病防治社会效益评估方法探讨及应用

Discussion and application of the social benefit assessment methods for tuberculosis control and prevention

采用卫生经济学最常用的成本-效果、成本-效用、成本-效益3种方法,对《全国结核病防治规划(2001—2010年)》(简称《规划》)实施期间社会效果、社会效用和社会成本3个方面进行评估。资料来源于《规划》终期评估报告和《中国统计年鉴2011》。结果表明,《规划》实施期间社会投入各种资源共计约83.6亿元人民币(下同),通过成功治疗431万例传染性结核病患者,使3231万名(1939～4847万名)健康人免受传染,避免了约323万名(194～485万名)健康人成为肺结核患者,为社会节约了22.6亿元(13.6～33.9亿元)医疗费用支出。另一方面,通过成功治疗患者,使劳动力人口中的患者恢复了健康,减少了社会生产力的损失,共挽回了3894.4亿元的社会经济损失。在现有的人员和设施、设备基础上,政府每额外投入1元,就能产生46.8元的经济效益。每避免1名健康人受传染,仅需投入259元。每挽回1个DALY损失,仅需投入272元。规划的实施取得了很好的社会经济效果,建议各级政府持续加大对结核病防治工作的投入。

Three most common methods in Health Economics such as cost-effectiveness,cost-utility,cost-benefit were employed to assess the social effect,social utility and social cost during the implementation of the National Tuberculosis Control Programme（2001—2010）（referred to as the ＂NTP＂）.Data come from ＂NTP＂ final assessment report and China Statistical Yearbook-2011.The results showed that the total of about 8.36 billion yuan of a variety of resources were invested during the implementation of the＂NTP＂,successfully treated with 4.31 million cases of infectious TB patients,prevented 32.31（19.39-48.47） million healthy people from infection,about 3.23（1.94-4.85） million healthy people were avoided becoming pulmonary tuberculosis cases,and 2.26（1.36-3.39） billion yuan of medical cost was saved.On the other hand,about 389.44 billion yuan of the social and economic lo-sses altogether were saved because of patients’ recovery and social productivity loss reduction with successful treatment.On the basis of the current staff and facilities,additional input of the government with one yuan can produce the economic benefits of 46.8 yuan.Only 259 yuan needed to avoid a healthy person infected and only 272 yuan needed to save the loss of a DALY.The implementation of the ＂NTP＂ has achieved good social and economic effects,and it is recommended that the government at each level continues to increase the investment of TB control.