急性病毒性肝炎最佳诊断策略的成本效益分析

Most effective etiologic diagnosis strategy of acute viral hepatitis in China

目的 探讨急性病毒性肝炎病原学分型诊断最优策略 .方法 收集中国生物医学文摘 (CBMD) 1987/1999的所有相关文献 ,进行系统综述、成本效益和灵敏度分析 .结果 以 HAV→ HBV→HEV→HCV分型策略进行分型诊断的成本效益比 (CER) 17.9,HAV→ HBV→ HCV→ HEV分型策略的CER为 18.7,HBV→ HAV→ HCV→ HEV CER为 19.0 ,其余策略均大于 2 0 .年龄和试剂盒价格对分型策略影响不大 .但如果乙肝病例占总病例的 48.3%时 ,策略 HBV→ HAV→HEV→ HCV的 CER(15 .1)最低 .结论 甲、乙、丙、戊型肝炎同时检测成本较高 ,策略 HAV→ HBV→ HEV→ HCV是最佳策略 ,但乙型肝炎病例占 48.3%以上时 ,策略 HBV→ HAV→HEV→ HCV为最佳 .

AIM To seek the most effective etiologic diagnosis strategy of acute viral hepatitis in China. METHODS We collected all of related literatures in Chinese Biological Medicine Digest (CBMD) from 1987 to 1999. Then systematic review, cost effectiveness and sensitivity analysis were employed. RESULTS Cost effectiveness ratio (CER) value was 17.9 in the diagnosis strategy with the sequence of hepatitis A virus (HAV), then to hepatitis B virus (HBV), to hepatitis E virus (HEV), and to hepatitis C virus (HCV), 18.7 with the sequence of HAV, HBV, HCV, to HEV, and 19.0 with the sequence of HBV, HAV, HCV, to HEV. The CER value in other strategies were higher than 20.0. The age of patients and the price of kits had little effect in different strategies. While the number of hepatitis B cases counted for over 48.3% in all cases with hepatitis in an area, the CER value in the strategy from HBV, then to HAV, to HEV, and to HCV was the lowest. CONCLUSION At present, the etiologic diagnosis strategy with the sequence of HAV, then to HBV, to HEV, and to HCV was the most economic in China.