育龄人群孕前优生中医预防保健服务包的成本-效果分析

Cost-effectiveness Analysis on the Health Service Package of Traditional Chinese Medicine Preventive Treatment of Preconception Care for Women of Childbearing age

目的:评估孕前优生中医预防保健服务包改善女性生育能力的成本效果,为推广中医治未病在育龄人群中的应用提供决策依据。方法:采用整群随机抽样方法,抽取河南省焦作市和新乡市7个区县,选择2015年12月—2016年1月参加孕前优生健康检查的育龄妇女(806人)纳入研究。干预组在优生健康指导的基础上,应用项目专家组编制的孕前优生中医预防保健服务包对不同体质的育龄妇女进行干预;对照组仅采用传统的优生健康指导,不辅以中医体质干预措施。在干预后第6个月评价育龄女性的受孕情况。利用全成本测算法对干预组和对照组的成本进行核算,并计算成本-效果比。结果:干预组6个月成功受孕率为35.81%,对照组为23.83%,差异有统计学意义(P=0.001 4)。成本-效果分析后发现,干预组每成功受孕1例的成本为385.46元,对照组为534.90元,中医预防保健服务包具有较好的成本-效果比。敏感度分析发现,在人员工资水平正常波动范围内,本研究结果趋于稳定。结论:孕前优生中医预防保健服务包在改善育龄女性生育力方面优于传统的优生健康指导,且成本效果更佳。

Objective： To evaluate cost-effectiveness of the health services package of traditional Chinese mcdicine（TCM） preventive treatment of disease improving fertility of women, providing evidence for the application of TCM preventive treatment of diseases among women who prepare to get pregnant. Methods： 7 city districts and counties were selected by cluster randomized sampling method. and 806 women who prepared to get pregnant were selected as the objects of the study between december 2015 and January 2016. For intervcnient group, besides conventional health education, TCM constitution of women were also identified and adjusted by heahh services pack of TCM preventive treatment of disease. For control group, only conventional health education was applied for women of childbearing age. The pregnancy rate of women was evaluated after 6 months. Economic evaluation was made by calculating the cost-effectiveness ratio. Results： The pregnancy rate of intervenient group and control group were 35.81% and 23.83% separately. The differences had statistical significance（P=0.0014）. According to the cost-effectiveness analysis, the cost to pay for managing fee per pregnancy was 385.46 yuan for intervenient group and 534.90 yuan for control group. Health services pack of TCM preventive treatment of disease had a better cost effectiveness ratio. Besides, the resuh of this study remained stable when employees＇ salaries tluctuated in normal range. Conclusion： Health services package of TCM preventive treatment of disease had a better effectiveness in improving fertility of women than conventional health education, and the cost-effectiveness of intervention was hetter than the control group.