深圳市2006-2030年乙型肝炎免疫预防策略的经济学评估和预测

Economic evaluation and prediction of hepatitis B immunization strategy in Shenzhen, China

目的 对深圳市2006-2030年乙型肝炎免疫预防策略的成本、经济学效益和效果进行评价和预测。方法 采用乙型肝炎疫苗新生儿普种策略经济学模型和乙型肝炎母婴阻断策略经济学模型，对2006-2015和2016-2030年深圳市乙型肝炎免疫预防策略的成本、经济学效益和效果进行评价和预测。模型参数包括乙型肝炎表面抗体阳转率、围产期HBV感染率、孕妇HBsAg筛检率和阳性率、乙型肝炎相关疾病效用值和Markov模型参数，以及乙型肝炎的疫苗接种率、免疫预防费用和相关疾病费用。从支付者、医疗卫生和全社会角度对成本进行计算和预测；采用避免的HBV感染和乙型肝炎相关疾病例数、寿命年（LY）、质量调整生命年（QALY）、净效益和效益成本比（BCR）对免疫策略的效果和效益进行评价和预测。结果 2006-2030年，从支付者、医疗卫生和全社会角度，深圳市乙型肝炎免疫预防策略总成本分别为1.53亿、55.17亿和109.23亿元，其中2016-2030年预测成本分别为1.20亿元、38.74亿元和78.10亿元。2006-2030年实施免疫策略可避免发生HBV感染和乙型肝炎相关疾病的人数为248.04万；累计可多获得133.51万LY和161.94万QALY；从医疗卫生与全社会角度，可获净效益分别为886.89亿和1 501.39亿元，BCR分别为17.08和14.75，其中，2006-2015年所获净效益（分别为223.72亿和379.83亿元）和BCR（分别为14.62和13.20）均低于2016-2030年净效益（分别为663.17亿和1121.56亿元）和BCR（分别为18.12和15.36）。结论 深圳市乙型肝炎免疫预防项目具有较高的经济学效果和效益，值得持续性投入。

Objective To verify the costs, benefit and effectiveness of hepatitis B immunoprophylaxis strategies in Shenzhen during 2006-2030.Methods The markov model was constructed to reflect the reality of the newborn vaccination and prevention of mother to child transmission （PMTCT） strategy, the cost, benefit and effectiveness during 2006-2015 and 2016-2030 was evaluated and predicted by the model. The model was constructed with the basic parameters such as the positive rate of hepatitis B surface antibody, perinatal HBV infection rate, the screening rate and positive rate of HBsAg of pregnant women, the utility value of hepatitis B and the parameters of markov model. and the coverage rates, vaccination fee of hepatitis B and the expenditures of patients with HB-related diseases.The costs were calculated from the payer, medical-care and all society perspective. The effectiveness and benefits of the strategy were evaluated and predicted by the numbers of HBV infection and the patients with HBV-related diseases prevented, life years （LYs）, quality adjusted life years （QALYs）, the net benefits （NBs） and benefit cost ratio （BCRs）.Results From the payer, medical-care and all society perspectives, the costs for the strategy were 153 million Yuan, 5.51 billion Yuan and 10.92 billion Yuan, respectively from 2006 to 2030 of which the forecast costs for 2016-2030 were 120 million Yuan, 3.87 billion yuan and 7.81 billion yuan. During the year 2006-2030, the numbers of HBV infection and the HBV-related diseases was 2.48 million, more than 1.335 million LYs and 1.619 million QALYs should be obtained from the strategy implemented. From medical-care and all society perspectives, NBs should be 88.68 billion yuan and 150.13 billion yuan with the BCRs of 17.08 and 14.75, respectively. Particularly, the NBs value of 22.37 billion yuan and 37.98 billion yuan and the BCR value of 14.62 and 13.20 was calculated for the past period, but the future NBs of 66.31 billion yuan and 112.15 billion yuan and BCR of 18.12 and 15.36 in the year 2016-2030. The further benefits were increased evidently in the future.Conclusion The hepatitis B immunization in Shenzhen has a high economic effectivenee and benefits, and it is worth to invest sustainably.