摘要
分 7个不同的年龄组队列 ,比较接种甲型肝炎 (甲肝 )减毒活疫苗 ( H2 株 )后 15年每一队列人群接种与否甲肝感染及发病的差异 ,并根据甲肝患病及甲肝疫苗接种的医疗费用和对质量修正生命年 ( QAL Y)的影响 ,推算接种的费用效果比 ( CER)。不接种情况下推算的不同年龄别人群发病率与本次研究人群的实际资料接近 ,说明计算模型可靠。基础假设的结果显示 ,每获得一个QAL Y,全人口组的平均费用是 152 2 77.60元 ,超过同期人均生产总值的 11倍。各年龄组单位效果的费用变化范围从 113369.30元 ( 10～ 19岁组 )到 2 92 138.30元 (≥ 50岁组 )。但对高危人群接种的分析显示 ,其 CER显著改善。所以 ,甲肝疫苗在中等疫情的城市人群中普遍使用是不合算的 ;预防接种应只面向高危人群。另外 ,灵敏度分析显示主要参数的改变均不会改变本文的结论。
The changes of annual incidence rates were predicted for7cohorts of different ages either with or without vaccination.Cost- effectiveness ratio( CER) was estimated by the annual dif- ferences of HA incidence of the two scenarios at15years after inoculation,the medical costs and quality of life impact( QAL Y) for conditions related to the vaccination and disease.The estimated age specific HA incidence rates of the cohorts without vaccination fitted the observed age specific HA incidence rates quite well,indicating the correctness of our calculation models.Under the base- case assumptions,vaccination in general population would entail medical costs.The average CER was 1532 77.6Yuan/ QAL Y,11times more than the average per- capita GNP in 1994 .The basecase CERs varied from 113369.3Yuan/ QALY in 10 - 19years of age to 2 92 138.3Yuan/ QAL Y in age group 50 - years.However,much better CERs are found when vaccination is directed toward a high risk population.In this case,widespread use of HAV vaccine in general population with intermedi- ate epidemicity would not be cost- effective while it should be only focused on the high risk popula- tion.Sensitivity analysis showed that none of the basic variables might change this conclusion.
出处
《中华流行病学杂志》
CAS
CSCD
北大核心
1998年第2期93-96,共4页
Chinese Journal of Epidemiology
基金
中华医学基金会和九.五攻关资助
