我国西南两省吸毒人群针具交换工作的卫生经济学评价

Economic evaluation of needle and syringe exchange in two provinces of Southwest China

目的 测算我国西南两省吸毒人群针具交换工作的成本、效果和效益.方法 于2012年9月至2013年2月间,在我国西南A、B两省的31个项目县通过查阅资料和调查问卷收集2009年7月至2010年6月、2010年7月至2011年6月、2011年7月至2012年6月共3个年度间针具交换的成本、效果和效益,以每分发1支针具的成本和每干预1名注射吸毒人员的成本作为单位成本分析指标,以开展针具交换工作所避免感染HIV的人数作为效果评价指标,以针具交换所避免感染HIV人员的抗病毒治疗费用、住院治疗费用和随访检测费用3部分作为效益评价指标.利用艾滋病防治资源需求与效果分析系统（NEAR系统）测算针具交换避免吸毒人群感染HIV的人数.采用x2检验对两省在各自分配领域的投入比重进行比较.结果 2009年7月至2012年6月,两省在针具交换工作中累计投入25 374 041元,A省投入最多的是管理费用领域（1 848 485元）,B省投入最多的是综合干预费用领域（5 452 355元）.每分发1支针具的成本为3.67元,随着分发针具数量增加单位成本在A省从第1年度的6.96元/支降至第3年度的4.01元/支,在B省从第1年度的3.38元/支降至第3年度的2.17元/支;每干预1名注射吸毒人员的成本为712.71元,随着干预的吸毒人员数量增加,单位成本在A省从第1年度的882.85元/名降至第3年度的574.95元/名,在B省从第1年度的760.48元/名降至第3年度的625.07元/名.两省通过针具交换工作共避免了1 307名吸毒人员感染HIV,每避免1名人员感染的成本为19 413.96元,通过开展针具交换避免的损失合计为367 507 488元,与开展针具交换工作的投入相比可得针具交换工作的成本效益比为14.48.结论 针具交换工作的投入能够获得较大的成本效益比,具备成本效益价值.

Objective To measure related cost,effectiveness and benefit of needle and syringe exchange（NSP） in two provinces of Southwest China.Methods Between September 2012 and February 2013,program files and questionnaires were used to collect the information about cost,effectiveness and benefit of NSP during three program years（July 2009 to June 2010,July 2010 to June 2011,July 2011 to June 2012） in 31 counties of two provinces of Southwest China.Unit cost indicators including cost of providing per syringe and cost of covering per IDU,number of new HIV infections avoided by providing needle and syringe exchange were used to evaluate the effectiveness of NSP,and the benefit indicators included the fees for ART,hospitalization cost and follow up of new HIV infection avoided by NSP.NEAR model was used to calculate the cases averted by NSP.Chi-square test was used to analyze the different percentage of allocation areas between two provinces.Results Between July 2009 and June 2012,25 374 041 yuan were totally used for NSP.In province A,the top investment area was management （1 848 485 yuan） while it was comprehensive intervention（5 452 355 yuan） in province B.The cost of providing per syringe was 3.67 yuan,and it decreased from 6.96 to 4.01 in province A and decreased from 3.38 to 2.17 in province B with the increasing needles distributed.The cost of covering per IDU was 712.71 yuan and the unit cost decreased from 882.85 to 574.95 in province A and decreased from 760.48 to 625.07 in province B with the growing number of IDUs intervened.A total of 1 307 new HIV infection were avoided by providing NSP,so 19 413.96 yuan would be used to avoid per IDU infecting HIV.A total of 367 507 488 yuan of HIV/AIDS related expenditure were avoided by NSP and the cost benefit ratio was 14.48.Conclusion NSP has a good cost-benefit ratio and should be promoted.