健康男性包皮环切术预防艾滋病的经济学分析

Economic Analysis of HIV Prevention by Circumcision Among Healthy Men

目的:评价四川省凉山彝族自治州健康男性包皮环切术预防HIV感染的有效性与经济性,为艾滋病防治合理配置资源提供参考。方法:采用动力学模型对四川省凉山彝族自治州人群进行艾滋病感染与进展进行长期模拟,直至全部人群均进入死亡状态(每1年作为1个循环周期),分别计算实施包皮环切术人群与不干预人群的成本与健康产出,根据健康产出判断其有效性,结合意愿支付阈值判断包皮环切术预防HIV感染的经济性。结果:实施包皮环切术预防HIV感染具有有效性,与不实施干预相比,增量成本效用比为298000.27元/QALY,大于3倍中国人均GDP,不具备经济性,不确定分析(单因素敏感性分析和概率敏感性分析)显示结果稳定。结论:实施包皮环切术来防治艾滋病具有有效性,但不具备经济性。可建议性行为较为活跃人群实施包皮环切术来降低HIV感染风险。

Objective:To evaluate the effectiveness and economy of circumcision for prevention of HIV infection among healthy men in Liangshan Yi autonomous prefecture of Sichuan province, to provide basis for the rational allocation of resources for AIDS prevention and control. Methods: A dynamic model was constructed to stimulate the long-term process of HIV infection and progression among population in in Liangshan Yi autonomous prefecture of Sichuan province and one year was set as a cycle until all people entered into the state of death, then the cost and health output between circumcision population and non-intervention population were calculated respectively. The effectiveness of circumcision and its economy for prevention of HIV infection were judged based on health output and willing to pay threshold separately. Results: The implementation of circumcision was effective in preventing HIV infection. Compared to no intervention, the incremental cost-utility ratio of circumcision was 298000.27 yuan/QALY, which was more than 3 times China’s per capita GDP and did not have cost-effectiveness. Uncertainty analysis including single factor sensitivity analysis and probability sensitivity analysis indicated the stability of results. Conclusion: Circumcision is effective but not economical in preventing HIV infection. Therefore, people who are sexually active are advised to conduct circumcision to reduce the risk of HIV infection.