山东省甲型肝炎减毒活疫苗纳入扩大免疫规划的卫生经济学评价

Health and Economic Evaluation of Introducing Hepatitis A Attenuated Live Vaccine into the Expanded Program on Immunization in Shandong Province

目的评估甲型肝炎（甲肝）减毒活疫苗（Hepatitis A Attenuated Live Vaccine,HepA-L）纳入山东省扩大免疫规划（Expanded Program on Immunization,EPI）的效果和效益。方法采用普查的方式进行自我填报式问卷调查获得免疫规划工作的总成本,利用专家咨询法确定非疫苗和注射器购置成本在不同针对传染病中的分配系数,用于测算控制甲肝的成本;将研究时期分为纳入EPI前和纳入EPI后进行成本效果分析、成本效益分析和成本净效益分析。结果山东省2008年将HepA-L纳入EPI,2008~2014年防控甲肝成本为33 086.80万元,减少发病155 848例,减少死亡70例,即每投入1万元可以减少发病4.71例,减少死亡0.002例;纳入EPI后与纳入EPI前相比,成本总经济效益比为1∶3.88、成本净效益比为1∶2.88,即每投入1元可以产生3.88元的总效益和2.88元的净效益。结论山东省将HepA-L纳入EPI可以获得较高的成本效果比和成本效益比,实现政府资源的有效配置。

Objective To evaluate the effectiveness and benefits of introducing hepatitis A attenuated live vaccine（ HepA-L） into the Expanded Program on Immunization（ EPI） in Shandong province.Methods A self-administered questionnaire was used to determine the total cost of EPI in Shandong,and the Delphi method was used to determine distribution coefficients of other expenses,except vaccine and syringe expenses,for calculating the cost of controlling Hepatitis A.Study periods were divided into two stages-before and after introducing HepA-L into EPI-to determine cost-effectiveness,cost-benefit ratios,and costs-net benefits.Results In 2008,HepA-L was introduced into EPI in Shandong.During 2008 to 2014,the total cost of controlling Hepatitis A was 330 868 thousand RMB,and 155 848 hepatitis A cases and 70 deaths were prevented,for a decrease of 4.71 cases,or 0.002 deaths per 10 thousand RMB.In contrast with the period before introduction of HepA-L,the cost-benefit ratio and cost-net benefit ratios were 1∶ 3.88 and 1∶ 2.88,respectively,for a benefit of 3.88 RMB,or a net benefit of 2.88 RMB per 1RMB investment.Conclusions Introduction of HepA-L into Shandong EPI had high cost-effectiveness and a high cost-benefit ratio,and achieved effective allocation of governmental resources.