血液筛查ELISA灰区设定的血站支出成本与效果的卫生经济学评估

Health economics evaluation of the cost and effectiveness of gray zone setting in blood ELISA screening

目的 建立ELISA灰区策略的卫生经济学评估模型,分析ELISA灰区设定策略的成本-效果。方法 由筛查策略选择树、病原体感染子决策树和病原体检测子决策树3部分组成血清学灰区策略评估模型,从文献和资料中获得模型中的关键参数,通过计算比较设置ELISA灰区策略的成本-效果,并进行多因素敏感性分析。结果 实施ELISA灰区设定的策略后,可额外检测出血清学假阴性标本5.86例/10万人次,其中包括HBV标本为4.93例/10万人次,HCV标本为0.27例/10万人次,HIV标本为0例/10万人次,梅毒标本为0.66例/10万人次。但灰区策略设定后,血站为每10万人次检测中增加1例感染标本的血清学检出,需额外负担约100万元的费用。结论 通过本研究建立了一套血清学检测策略的成本-效果评价模型。虽然ELISA灰区设置策略可以筛查出少量的血清学阳性标本,但付出的成本远高于目前的可承受能力。

Objective To analyze the cost-effectiveness of ELISA grey area strategy through establishing the health economics model.Methods The serological grey area strategy evaluation model was composed of screening strategy subdecision tree,pathogen infection subdecision tree and pathogen detection subdecision tree.The key parameters in the model were obtained from literatures and research data.The cost-effectiveness of setting ELISA grey area strategy was compared by software,and multifactor sensitivity analysis was conducted.Results After setting the ELISA grey area,extra samples(5.86 cases/100 000) with serological false negativity could be detected,including HBV samples at 4.93/100 000,HCV samples at 0.27/100 000,HIV samples at 0/100 000,syphilis samples at 0.66/100 000.To yield an additional seropositive sample out of every 100 000 blood donors,blood center will afford extra 1 million yuan about.Conclusion Through this study,a cost-effectiveness evaluation model of serological detection strategy was established.Although the ELISA grey area setting can yield a small number of seropositive samples,the cost is much higher than the current affordability.