北京市1992—2013年乙肝疫苗免疫规划对急性乙肝成本效果分析

Cost-effectiveness of hepatitis B vaccine immunization program in control of acute hepatitis B in Beijing, 1992-2013

目的评价北京市1992—2013年急性乙肝报告发病率指标与乙肝疫苗免疫规划总成本之间的成本效果关系。方法以乙肝疫苗免疫规划总成本为成本指标,对急性乙肝发病率进行成本效果分析,主要包括成本分析、增量成本效果比以及边际效果分析。结果1992—2013年间北京市乙肝疫苗接种的总成本增加,人力成本占比上升;随着乙肝疫苗免疫规划总成本的增长,急性乙肝发病率先增长后下降,由1992年的3.58/10万人下降到2013年的1.34/10万人;多期间增量成本效果比方面,1999—2005年这一期间的增量成本效果比较好。结论乙肝疫苗成本变化符合实际发展规律;急性乙肝发病率的变化可能与流动人口中乙肝病毒携带者数量增加、传染病报告规定变化、乙肝诊断标准变化以及机构投入优化有关;急性乙肝的发病率随成本投入的增加而下降,但是最优组合尚未出现,可进行乙肝疫苗免疫规划的跟踪评估并结合实际调整防控策略。

Objective To evaluate the cost-effectiveness relationship between the reported incidence of acute hepatitis B and the total cost of hepatitis B vaccine immunization program in Beijing from 1992 to 2013.Methods The total cost of hepatitis B vaccine immunization program in Beijing from 1992 to 2013 was considered as the cost indicator,and then we conducted the costeffectiveness analyses based on the incidence of acute hepatitis B,mainly including the analyses of cost,incremental cost-effectiveness ratio and marginal effectiveness.Results The total cost of immunization with hepatitis B vaccine in Beijing in 1992-2013 went up,and the proportion of manpower cost also increased.With the increment of total cost of hepatitis B vaccine immunization program,the reported incidence of acute hepatitis B rose first and then declined,decreasing from 3.58/100,000 in 1992 to 1.34/100,000 in 2013.The incremental cost-effectiveness ratio for the duration from 1999 to 2005 was better.Conclusions The changes of the cost of immunization with hepatitis B vaccine in Beijing in 1999-2013 accorded with the actual development of society.The fluctuation of the reported incidence of acute hepatitis B might be related to the increase of hepatitis B virus carriers in migrants,the variation in the infectious disease reporting regulation,the introduction of new hepatitis B diagnostic criteria,and the optimization of institutional investment.Although the reported incidence of acute hepatitis B declines with the increase of the cost of immunization with hepatitis B vaccine,the optimal result has not yet appeared.The follow-up evaluation of hepatitis B vaccine immunization program should be conducted and the prevention and control strategy should be adjusted based on the actual situation.