新生儿乙型肝炎疫苗普遍接种阻断乙型肝炎病毒慢性感染的成本-效果评估

Cost-effectiveness Evaluation on Universal Vaccination against Chronic Hepatitis B Virus Infection in China

为了评估中国目前新生儿乙型肝炎 (乙肝 )疫苗预防接种阻断乙肝病毒 (HBV)慢性感染的成本 效果及其影响因素 ,以近 1 1年中国年平均新生儿人口作为观察队列 ,按HBV感染本底和自然转归来推算HBV自然感染的后果 ,以新生儿乙肝疫苗保护效果为 90 %估计干预后HBV感染状况 ,以每接种 1 0 0 0份 (3剂 ,下同 )乙肝疫苗预期所阻断的慢性携带者人数和慢性肝病患者例数作为乙肝疫苗预防HBV慢性感染的成本 效果。结果显示 :中国HBV慢性持续感染的分布有明显的地区性 ;中流行区HBV慢性携带者的流行率比特高流行区低 2 5倍 ;HBV慢性携带者流行率高的人群 ,乙肝疫苗的成本 效果相对较高。同样接种 1 0 0 0份乙肝疫苗 ,在中流行区可减少 67名慢性携带者和 1 7例慢性肝病患者 ,在特高流行区则可阻断 1 64名慢性携带者和 41例慢性肝病患者。中国目前推广新生儿乙肝疫苗预防接种 ,平均每 1 0 0 0份乙肝疫苗将可减少 98名慢性携带者和 2 5例慢性肝病患者。中国各地目前推广乙肝疫苗预防接种的成本 效果均非常高。同时 ,乙肝疫苗的成本 效果与免疫策略和HBV感染的流行率密切相关。

This paper was to evaluate the cost effectiveness and the affecting factors of the universal infant hepatitis B vaccination. The Chinese birth cohort was supposed by national average infant population from 1990 2000;chronic HBV carriers and chronic liver diseases(CLDs)without vaccination were estimated in accordance with baseline and natural history of HBV infection;chronic HBV carriers and CLDs after universal infant vaccination were based on 90% efficacy of universal infant hepatilis B immunization program; cost effectiveness of universal infant vaccination was expressed by both prevented carriers and CLDs per 1000 person time vaccines There were considerable geographical differences on prevalence of chronic HBV carriers nation wide;prevalence of chronic carriers in super high endemic area was 2 5 times higher than that in intermediate area;universal infant vaccination was more cost effective in super high endemic area than that in intermediate area;67 carriers and 17 CLDs could be prevented by 1000 vaccines in intermediate endemic area; however, 164 carriers and 41 CLDs could be prevented by 1000 vaccines in super high endemic area. Nationally,current cost effectiveness of universal infant hepatitis B vaccination was that: a total of 98 chronic HBV carriers and 25 CLDs could be prevented per 1000 person time hepatitis B vaccines These results showed that current cost effectiveness of universal Chinese infant hepatitis B vaccination was pretty high nation wide,however,the cost effectiveness could be affected by prevalence of HBV infection and immunization strategy