CD4^+T淋巴细胞计数检测与HIV病毒载量检测在评价ART效果中的经济性比较及其影响因素

Cost effectiveness of two HIV monitoring methods and its influence factors

目的评价CD4+T淋巴细胞(简称CD4细胞)计数与艾滋病病毒(HIV)病毒载量检测,对于HIV检测与病情诊断和治疗监测的经济性。方法设定检索时间与检索关键词,查阅中英文文献,比较两种检测技术的经济性,并分析其影响因素。结果相比仅依靠CD4细胞计数指导治疗,病毒载量检测指示的抗病毒治疗(ART)能够带来更好的治疗效果和健康结果,但是成本较高。在社会经济发展程度不高的地区,尚没有绝对的证据证明病毒载量检测较CD4细胞计数检测的经济性;而在经济较发达地区,病毒载量检测技术显示出更好的经济性;两种技术共用时,较CD4细胞计数单独使用时往往不具有经济性;仅在南非等经济较发达地区,合并使用两种检测技术更具备成本效果。ICER阈值、具体的检测方案、包含的成本范围以及考虑的健康收益范围,通常是影响经济性评价的重要因素。结论在资源限制的欠发达地区,CD4细胞计数显示出较好的经济性,应优先使用;在经济发展水平较好的地区,可尝试发展和使用病毒载量检测技术,或联合CD4细胞计数共同使用以指导ART。

Objective To evaluate the cost effectiveness of CD4 cell counts and HIV RNA viral load in the testing,diagnosis and monitoring of antiretroviral therapy（ART）.Methods Systematic review was made to search the literatures in both Chinese and English.Results Viral load detection provides better treatment effect and health outcomes comparing to merely using CD4 cell counts.HIV RNA viral load test is more cost effective in well developed regions compared to CD4 cell counts,while its cost effectiveness cannot be seen in low-resource settings.Combing the two technologies was not as cost effective as adopting CD4 cell counts alone,except in the well-developed regions such as in the South Africa.ICER threshold,specific testing method,the scope of costs and health benefit included were important factors affecting the results of economic evaluation.Conclusion CD4 cell counts is proven to be more cost effective in resource limited settings and should be given priority to in practice.In wealthier regions,the utilization of viral load test and the combination of the two technologies should be considered to guide ART treatment.