广西壮族自治区1992～2013年新生儿乙型肝炎疫苗接种效果及预防效益分析

Analysis of Effectiveness and Cost-effectiveness of Hepatitis B Immunization of Newborns in Guangxi Zhuang Autonomous Region,1992-2013

目的揭示广西自1992年乙型肝炎（乙肝）疫苗（HepB）纳入计划免疫管理和2002年新生儿HepB纳入免疫规划以来预防乙肝病毒（HBV）感染传播的效果。方法收集HepB接种资料,1992年、2006年及2013年全国乙肝血清流行病学调查结果,以及2006年、2012年广西乙肝血清流行病学调查资料进行综合分析。结果广西1992~2013年共出生1608万儿童,HepB全程接种1538万人,全程接种率达95.64%。对在家出生新生儿补助20元使新生儿出生24小时内HepB首剂及时接种率提高10%。自2007年以后新生儿乙肝表面抗原（HBsAg）携带率已降至1%以下。22年HepB接种后估算减少HBsAg携带151.70万例、慢性乙肝15.17万例、肝硬化1.52万例和肝癌0.15万例;HepB接种估算总投入7.86亿元,总产出1 324.63亿元,投入产出比为1：168。结论广西新生儿HepB接种22年使HBsAg携带率在2007年后与全国同步实现1%以下的目标,有效预防了乙肝、肝硬化和肝癌,产生了巨大的社会效益和经济效益。

Objective This study was to determine the effectiveness and cost-effectiveness of hepatitis B vaccine（HepB） immunization of newborns.Methods Data on HepB immunization,the national seroepidemiological surveys of hepatitis B in 1992,2006 and 2014,and the provincial sero-epidemiological surveys in 2006 and 2011 were evaluated.Results The complete,3-dose immunization coverage of HepB among newborns was 95.64%（15.38 million /16.08 million） from 1993-2013 in Guangxi.The coverage rate of HepB1 administered within 24 hours of birth among home-born newborns increased by10% in counties with a 20-RMB compensation for each newborn,compared with counties without compensation.The hepatitis B surface antigen（HBs Ag） carrier rate among newborns has been less than 1%since 2007.We estimate that 1517 thousand HBs Ag carriers,151.7 thousand chronic hepatitis B infections,15.2 thousand liver cirrhosis,and 1.5 thousand primary liver cancer cases were prevented during1992-2013.The total estimated cost related to hepatitis B immunization was 786 million RMB,and the total estimated economic loss prevented was 132463 million RMB,for a 1：168 of cost-effectiveness ratio.Conclusions HepB immunization in Guangxi,as in all of China,led to the achievement of a HBs Ag carrier rate among infants less than 1% since 2007,effectively preventing hepatitis B infection,liver cirrhosis and primary liver cancer,yielding a huge social and economic benefit.