浙江省台州市扩大HIV检测策略的成本效果分析

Cost-effectiveness analysis of expanded HIV testing strategy in Taizhou, Zhejiang

目的 对浙江省台州市扩大HIV检测策略进行卫生经济学评价,为当地艾滋病防治策略制定提供依据.方法 通过问卷调查收集浙江省台州市2009—2013年HIV检测策略的实施情况,收集实施过程相关成本及效果信息.通过国家艾滋综合防治数据信息管理系统收集HIV检测发现阳性者数量、随访管理情况信息.利用Bernoulli-process模型计算性传播途径所避免的感染人数.以成本效果比为指标进行成本效果分析.结果 2009—2013年台州市累计HIV检测成本投入4335.5万元,总检测量达2798535人次,发现1421例（5.1/万）HIV感染者,其中纳入随访管理1164例（81.9％）.每新发现1例HIV感染者的平均HIV检测成本为30510.2元,每将1例新发现HIV感染者纳入随访管理平均HIV检测成本为37246.6元.基于Bernoulli-process模型估计,期间累计避免因性接触传播的新发HIV感染人数约为3105（范围：2525～3787）人,成本效果分析显示,每避免1例HIV感染者平均需要13963.0（范围：11448.4～17170.3）元HIV检测成本投入.结论 台州市扩大HIV检测策略经济效益、公共卫生效益较好.可以考虑在艾滋病高危人群或重点人群中进一步实施扩大HIV检测策略,同时还要做好阳性者的随访管理工作.

Objective To evaluate the expanded HIV detection strategy in Taizhou of Zhejiang province by using the cost-effectiveness analysis, so as to provide evidence of AIDS prevention strategy formulation. Methods Based on field investigation, the implementation of HIV detection strategy in Taizhou during 2009-2013 was investigated by questionnaire survey to collect related cost and effectiveness information. The amount of HIV positive-detected patients and information of follow-up visit were collected through national AIDS comprehensive control data and information system. The Bernoulli-process model was used to calculate the number of infections through sexual transmission avoided by expanded HIV testing strategy. The ratio of cost and effectiveness was regarded as the index to analyze cost effectiveness. Results From 2009 to 2013, the total cost of HIV testing strategy in Taizhou was 43.355 million yuan. A total of 2798535 persons were tested, and 1421 were found HIV infected （5.1/10000）, among whom 1164 （81.9%） were included in the follow-up management. The average cost of HIV detection for finding each new case of HIV infection was 30510.2 yuan, and the average cost of HIV detection for bringing each new case of HIV infection into the follow-up management was 37246.6 yuan. Based on the Bernoulli-process model, the total number of HIV infections through sexual transmission avoided by expanded HIV testing strategy was about 3105 （range：2525-3787） persons. The cost effectiveness analysis showed that the average cost of HIV detection for avoiding each new case of HIV infection through sexual transmission was 13963.0 （range：11448.4-17170.3） yuan. Conclusions The expanded HIV testing strategy has great economic and public health benefits in Taizhou. It is better to further expand the HIV testing strategy in high-risk groups. At the same time, the follow-up management of positive patients needs to be taken into consideration.