摘要
目的 探讨美沙酮维持治疗（methadone maintenance treatment,MMT）拓展服药点的成本,进行成本效果、成本效用分析,为下一步推进MMT拓展服药点的策略提供依据.方法 以云南省德宏州所辖的芒市、瑞丽市、陇川县、盈江县、梁河县的17个MMT拓展服药点为研究现场,以于2010年12月至2011年2月招募的117例新入组接受MMT的海洛因成瘾者作为研究对象.分别在研究对象人组2周内及MMT拓展服药点治疗6个月后,由经过课题组统一培训的调查人员采用现场访谈形式获得其生活质量评分、吸毒费用；采用自制的云南省德宏州MMT门诊成本构成调查表收集、计算德宏州2008-2010年MMT拓展服药点固定成本和运转成本的构成和数额,服药人员的单位成本和增量成本.利用马尔科夫（Markov）模型对拓展服药点进行成本效果、成本效用分析.结果 云南省德宏州MMT拓展服药点2008-2010年平均总成本分别为57294、80752、74739元人民币,拓展服药点服药人员的年人均成本为4379元.减少1例HIV感染者的费用为316509元,减少1例艾滋病患者的费用为508676元,减少1例死亡的费用为152330元.获得一个生命年（life of years,LY）需投入的费用为3696元,获得一个质量调整生命年（quality adjusted life year,QALY）的费用为9014元.在拓展服药点美沙酮维持的治疗人群与吸毒人群相比,增量成本效用比（incremental cost-utility ratio,ICUR）为-7074元/QALY和-7162元/LY.结论 MMT拓展服药点成本相对较低,成本效果和成本效用均较好.
Objective To discuss the cost,cost-effectiveness,and cost-utility of the extension methadone maintenance treatment （MMT） clinics and provide the evidences of the strategy of scaling up the extension MMT clinics.Methods A study was conducted in Dehong prefecture,Yunnan province,including Mang,Ruili city,Longchuan,Yingjiang,Lianghe county.117 newly enrolling heroin addict patients in 17 extension MMT clinics were recruited as subjects from December 2010 to February 2011, An interview was conducted by the trained interviewers for the quality of life score of patients,and the cost of drug use was calculated.Table of outpatient costs of methadone maintenance treatment clinic of Dehong prefecture in Yunnan was used for collecting and calculating the fixed cost,operating cost of the clinics,and the unit cost and incremental cost of the patients from 2008 to 2010.Cost-effectiveness and cost-utility of the extension clinics were analyzed by using the Markov model.Results The total spending of extension clinics for 2008,2009,and 2010 on average was ￥57294,￥80752 and ￥74739 respectively,or about ￥4379annually per patient.The cost of averting one HIV infection was ￥316509; the cost of averting one acquired immune deficiency syndrome （AIDS） patients was ￥ 508676 ; and the cost of averting one death was ￥ 152330.The cost of obtaining one life year （LY） was ￥ 3696 and the cost of obtaining one quality adjusted life year （QALY） was ￥ 9014.Comparing with drug users,the incremental cost utility ratio （ICUR） of the patients of the extension MMT clinics were-7074 yuan/QALY and-7162 yuan/LY.Conclusion The extension MMT clinic service is lower in cost,and better in cost-effectiveness and cost-utility.
出处
《中华预防医学杂志》
CAS
CSCD
北大核心
2013年第11期996-1000,共5页
Chinese Journal of Preventive Medicine
关键词
吸毒人群
美沙酮
治疗结果
美沙酮维持治疗
效果
成本
Drug users
Methadone
Treatment outcome
Methadone maintenance treatment
Effectiveness
Cost
