自毁式注射器替代普通一次性注射器的成本-效益分析

Cost-benefit analysis on the replacement program of ordinary syringes by auto-disposal syringes in China

目的 对自毁式注射器 (AD)替代普通一次性注射器的安全注射措施进行成本 效益分析 ,探讨该措施的经济可行性。方法 现场调查乙型肝炎 (乙肝 )患者的直接医疗费用 ,并根据 1998年国家卫生服务调查资料和现场调查结果 ,计算乙肝所造成的失能调整生命年损失及其疾病经济负担。将安全注射减轻的乙肝患者疾病负担作为效益指标 ,并将AD替代普通一次性注射器增加的直接费用作为成本 ,对该干预措施进行成本 效益分析。结果 2 0 0 1年中国乙肝患者总的医疗费用为161.95～ 2 0 1.67亿元 ,年人均治疗费用为 175 5 .3 8～ 140 9.64元。AD代替普通一次性注射器方案的总效益成本比为 3 2 .46～ 97.3 9,具有良好的经济效益 ,且农村优于城市。当两种注射器的差价 >0 .2 4元时 ,AD替代方案的直接效益成本比值开始 <1。结论 用AD替代普通一次性注射器的方法来解决安全注射问题在经济上是可行的 。

Objective To explore the feasibility of replacement of ordinary syringes by auto-disposal syringes (AD) in China. Methods Sampling survey was conducted in Hebei province to collect data on the direct medical spending of hepatitis B and their Disability Adjusted Life Year (DALY) losses. The financial burden on hepatitis B was calculated based on the result of field survey as well as through data-base of the Second National Health Services Survey of MOH in 1998. The cost-benefit analysis was employed, in which the saving of the financial burden on hepatitis B patients attributing to unsafe injections was taken as the benefit of intervention and the increased expenditures of AD syringes as the costs. Results The total financial disease burden of Hepatitis B in China in 2001 was between RMB 16.19 and 20.17 billion Yuan and the financial disease burden per patient was between RMB 1 755.38 and 1 409.64 Yuan. Study on the cost-benefit analysis in the replacement intervention program showed high financial feasibility. The Benefit-Cost Ratio (BCR) of the measure was between 32.46 and 97.39, which was bigger in rural areas than that in cities. The direct BCR was less than one when the price gap between ordinary syringe and AD exceeded RMB 0.24 Yuan. Conclusion The intervention of safe injection practice through universal usage of AD to replace ordinary syringe seemed to be applicable due to its high potential economic benefits.