乙型肝炎母婴阻断策略成本效果可支付性分析

Cost-effectiveness and affordability of strategy for preventing mother-to-child transmission of hepatitis Bin China

目的分析我国乙型肝炎（乙肝）母婴阻断策略的成本效果价值，探索支付意愿和预算规模对项目持续投入的影响。方法以乙肝母婴阻断为研究策略，不接种为对照策略，采用决策分析马尔科夫模型，以我国2013年出生人口数为队列人群，通过TreeAge Pro2015软件实现模拟运行。分别从全社会和支付者角度计算成本，效果包括乙肝相关疾病人数和质量调整生命年（QALYs），策略间比较采用增量成本效果比（ICER）。由敏感性分析明确各参数的不确定性，绘制成本效果可支付曲线评价策略的可支付性。结果接受乙肝母婴阻断后终其一生所承担的成本为4063．5元／人，比不接种节省37829．7元从。人均获得QALYs为24．5161，与不接种策略相比增加明显，且可以减少乙肝相关疾病的发生。从全社会角度看，乙肝母婴阻断与不接种相比，每多获得一个QALYs分别可节省59136．6元，根据本研究成本效果阈值，说明乙肝母婴阻断具有成本效果价值。一维、多维和概率敏感性分析显示，上述结果稳定可靠。成本效果可接受曲线显示，结果不会因公众支付意愿变化而影响，且研究策略完全实现的支付意愿小于成本效果阈值。可支付分析显示，我国实施该策略的年预算在5．904亿～6．888亿元，不会超出财政支付能力；同一支付意愿下，年预算越高本研究策略具有经济性及可支付性的概率越高，只有当年预算达到6．888亿元，该策略才能完全实现。结论我国推行的乙肝母婴阻断策略具有成本效果价值，并未超出公众支付意愿和财政预算能力，顺应了全球消除乙肝的目标要求，值得大力实施和推广。

Objective To evaluate the cost effectiveness of nationwide prevention of mother to child transmission （PMTCT） strategy for hepatitis B, and estimate the willing to pay and budget impacts on the PMTCT. Methods The decision analytic Markov model for the PMTCT was constructed and a birth cohort of Chinese infants born in 2013 was used to calculate the cost-effectiveness of the PMTCT among them compared with those receiving no intervention. The parameters in the model were obtained from literatures of national surveys or Meta-analysis. The costs, cases of HBV-related diseases and quality-adjusted life-years （QALYs） were obtained from the societal and payer perspectives, respectively. The incremental cost-effectiveness ratio （ICER） was used as measures of strategy optimization. One-way and probability sensitivity analysis were performed to explore the uncertainty of the primary results. In addition, cost-effectiveness acceptability curve and cost-effectiveness affordability curves were drawn to illustrate the cost effectiveness threshold and financial budget of the PMTCT strategy. Results The lifetime cost for PMTCT strategy was 4 063.5 yuan （RMB） per carrier, which was 37 829.7 yuan （RMB） lower compared with those receiving no intervention. Due to the strategy, a total of 24.516 1 QALYs per person would be gained, which was higher than that in those receiving no intervention. From societal perspective, the ICER was -59 136.6 yuan （RMB） per additional QALYs gained, indicating that the PMTCT is cost effective. The results were reliable indicated by one-way, multi-way and probability sensitivity analyses. By the CEAC, the willing to pay was much lower than the cost-effectiveness threshold. From the affordability curve of the PMTCT strategy, the annual budget ranged from 590.4 million yuan （RMB） to 688.8 million yuan （RMB）, which was lower than the financial ability. Based on the results of cost-effectiveness affordability curves, the higher annual budget was determined, the higher probability of affordability for the PMTCT would be obtained under the same willing to pay state. Only when the annual budget reaches 688.8 million yuan （RMB）, the goal of PMTCT would be fully realized. Conclusions The PMTCT strategy in China was cost effective, and the cost is not beyond the financial budget needed and the willing to pay. The strategy, which is consistent with the global hepatitis B elimination efforts, should be conducted widely in China.