中國(guó)15歲以上人群乙型肝炎免疫預(yù)防的決策分析模型研究
發(fā)布時(shí)間：2018-07-21 10:02
【摘要】：目的建立我國(guó)15歲以上人群乙型肝炎免疫預(yù)防的決策樹(shù)-馬爾科夫模型,并對(duì)我國(guó)15歲以上人群乙肝免疫預(yù)防的各種方案進(jìn)行綜合評(píng)價(jià),篩選出最佳方案,為衛(wèi)生行政部門(mén)制定乙型肝炎免疫接種策略提供依據(jù)。 方法通過(guò)現(xiàn)場(chǎng)調(diào)查,確定不同HBV感染狀態(tài)的經(jīng)濟(jì)負(fù)擔(dān),利用Meta分析的方法綜合國(guó)內(nèi)外與乙肝相關(guān)的研究,計(jì)算HBV感染率和抗-HBs陽(yáng)轉(zhuǎn)率,同時(shí)考慮疫苗接種率、乙肝年新感染率、疫苗和接種費(fèi)、篩檢費(fèi)、貼現(xiàn)率、以及感染HBV后各轉(zhuǎn)歸率等因素,構(gòu)建我國(guó)15歲以上人群乙肝疫苗免疫預(yù)防決策樹(shù)-馬爾科夫模型,運(yùn)用TreeAge2009軟件對(duì)模型的各節(jié)點(diǎn)的益損值進(jìn)行計(jì)算,并用效益成本比作為評(píng)價(jià)各方案優(yōu)劣的指標(biāo),對(duì)方案進(jìn)行優(yōu)選,通過(guò)靈敏度分析探討不同因素對(duì)模型影響的大小。 結(jié)果1、我國(guó)15歲以上人群乙肝免疫預(yù)防策略是篩檢后接種優(yōu)于直接接種,且篩檢后接種的BCR都大于1,直接接種的BCR都小于1。 2、我國(guó)15歲以上人群乙肝免疫預(yù)防的最佳接種策略是篩檢3項(xiàng)（抗-HBs,HBsAg,抗-HBc)后按0－1-6月程序接種10μg乙肝疫苗。其中,15-19歲組最佳方案的BCR為2.40,每投入1229.59元,可產(chǎn)生2950.75元的效益,1721.16元的凈效益；20-29歲組最佳方案的BCR為3.22,每投入862.56元,可獲得2774.04元的效益,1911.49元凈效益；30-39歲組最佳方案的BCR為3.81,每投入680.09元,得到2591.16元效益,1191.07元凈效益；40-49歲組最佳方案的BCR為3.98,每投入5421.81元,獲得2157.92元效益,1615.12元凈效益；50歲以上組最佳方案的BCR為3.22,即每投入290.16元,可獲得935.20元效益,645.04元的凈效益。各年齡組的效益成本比隨著年齡的增加而升高,但獲得的總效益卻越來(lái)越低,該結(jié)果提示,投入在低年齡組將產(chǎn)生更大的社會(huì)效益。 3、根據(jù)乙肝免疫預(yù)防的各種方案,建立決策樹(shù)-馬爾科夫模型,并運(yùn)用成本效益分析方法,以BCR為方案評(píng)價(jià)指標(biāo),能較全面的評(píng)價(jià)各方案的優(yōu)劣情況。也就是說(shuō)決策樹(shù)-馬爾科夫模型對(duì)乙肝免疫預(yù)防策略的量化具有良好的適用性和可靠性 4、模型對(duì)各參數(shù)的靈敏度大小依次為HBVM陽(yáng)性率,疫苗接種率和接種后抗-HBs陽(yáng)轉(zhuǎn)率、疫苗及接種費(fèi)、篩檢費(fèi)、貼現(xiàn)率、HBV感染費(fèi)用。 5、HBV感染費(fèi)中無(wú)形費(fèi)用的加入與否,對(duì)乙肝疫苗接種策略的優(yōu)選順序暫時(shí)沒(méi)有發(fā)現(xiàn)影響。 結(jié)論1、我國(guó)15歲以上人群乙肝免疫預(yù)防策略篩檢后接種優(yōu)于直接接種,其最佳接種方案是篩檢3項(xiàng)(抗-HBs, HBsAg,抗-HBc)后按0－1－6月程序接種10μg乙肝疫苗。 2、構(gòu)建的決策樹(shù)-馬爾科夫模型對(duì)我國(guó)15歲以上人群乙肝免疫預(yù)防策略的定量?jī)?yōu)化具有良好的適用性和可靠性。 3、對(duì)模型影響較大的參數(shù)有HBVM陽(yáng)性率、疫苗接種率和接種后抗-HBs陽(yáng)轉(zhuǎn)率,而疫苗及接種費(fèi)、篩檢費(fèi)、貼現(xiàn)率、HBV感染費(fèi)用對(duì)模型影響較小。 4、尚未發(fā)現(xiàn)HBV感染費(fèi)用中無(wú)形費(fèi)用對(duì)乙肝疫苗接種方案優(yōu)選順序有影響。
[Abstract]:Objective to establish a decision tree-Markov model for hepatitis B immunization prevention among people over 15 years of age in China, and to evaluate comprehensively the various schemes of hepatitis B immunization prevention among people over 15 years old in China, and to screen out the best scheme. To provide basis for health administration to formulate hepatitis B immunization strategy. Methods the economic burden of different HBV infection status was determined by field investigation. The HBV infection rate and anti-HBs positive rate were calculated by meta-analysis, and the new HBV infection rate in the year of hepatitis B was taken into account. Based on the factors of vaccine and inoculation cost, screening fee, discount rate, and the rate of HBV infection, the decision tree of hepatitis B vaccine immunization prevention was constructed in China, and the Markov model of hepatitis B vaccine prevention decision tree was established in the population over 15 years of age. TreeAge2009 software is used to calculate the benefit and loss value of each node of the model, and the ratio of benefit to cost is used as the index to evaluate the merits and demerits of each scheme. The scheme is selected optimally, and the influence of different factors on the model is discussed through sensitivity analysis. Results 1. The immunization prevention strategy of hepatitis B in the population over 15 years old in China was better than direct inoculation after screening. The BCR inoculated after screening were all greater than 1, and the BCR inoculated directly were all less than 1.2. The best vaccination strategy for hepatitis B vaccination in China aged 15 years and above was to screen 3 items (anti-HBc) and then inoculate 10 渭 g hepatitis B vaccine according to 0-1-6 months program. The BCR of the best scheme for 15-19 years old group is 2.40. For each investment of 1229.59 yuan, it can produce 2950.75 yuan benefit and 1721.16 yuan net benefit. The BCR of the best scheme for 20-29 years old group is 3.22. For every investment of 862.56 yuan, the net benefit of 2774.04 yuan can be obtained. The BCR of the best scheme for 30-39 years old group is 3.81, with 680.09 yuan per investment, 2591.16 yuan net benefit is 1191.07 yuan net benefit. The best scheme for 40-49 years old group is 3.98. For each investment of 5421.81 yuan, the net benefit of 2157.92 yuan benefit is 1615.12 yuan. The BCR of the best scheme for the group over 50 years old is 3.22, that is, the net benefit of 935.20 yuan can be obtained for every 290.16 yuan invested. The ratio of benefit to cost of each age group increases with age, but the total benefit is getting lower and lower. The results suggest that investing in the lower age group will result in greater social benefits. 3 according to the various programs of hepatitis B immunization prevention, The decision tree-Markov model is established and the method of cost-benefit analysis is used to evaluate the merits and demerits of each scheme with BCR as the evaluation index. That is to say, the decision tree-Markov model has good applicability and reliability for quantification of hepatitis B immune prevention strategy. The sensitivity of the model to each parameter is HBVM positive rate in turn. Vaccination coverage rate, anti-HBs positive conversion rate after vaccination, vaccine and inoculation fee, screening fee, discount rate and HBV infection cost. 5 whether the invisible cost of HBV infection cost was added or not had no effect on the optimal selection order of HBV vaccination strategy for the time being. Conclusion 1. Vaccination after screening is better than direct inoculation in the population over 15 years of age in China. The best inoculation scheme was to screen 3 items (anti-HBs, HBsAg, anti-HBc) and then inoculate 10 渭 g hepatitis B vaccine according to the procedure of 0-1-6 months. 2. The decision tree Markov model was constructed to prevent hepatitis B in the population over 15 years of age in China. The quantitative optimization has good applicability and reliability. 3. The positive rate of HBVM has been found in the parameters that have a great influence on the model. Vaccination rate and positive rate of anti-HBs after vaccination, and cost of vaccine and inoculation, screening cost, The discount rate and the cost of HBV infection had little effect on the model. 4. It was not found that the invisible cost of HBV infection cost had influence on the selection sequence of hepatitis B vaccination program.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類(lèi)號(hào)】：R392.1
本文編號(hào)：2135164
[Abstract]:Objective to establish a decision tree-Markov model for hepatitis B immunization prevention among people over 15 years of age in China, and to evaluate comprehensively the various schemes of hepatitis B immunization prevention among people over 15 years old in China, and to screen out the best scheme. To provide basis for health administration to formulate hepatitis B immunization strategy. Methods the economic burden of different HBV infection status was determined by field investigation. The HBV infection rate and anti-HBs positive rate were calculated by meta-analysis, and the new HBV infection rate in the year of hepatitis B was taken into account. Based on the factors of vaccine and inoculation cost, screening fee, discount rate, and the rate of HBV infection, the decision tree of hepatitis B vaccine immunization prevention was constructed in China, and the Markov model of hepatitis B vaccine prevention decision tree was established in the population over 15 years of age. TreeAge2009 software is used to calculate the benefit and loss value of each node of the model, and the ratio of benefit to cost is used as the index to evaluate the merits and demerits of each scheme. The scheme is selected optimally, and the influence of different factors on the model is discussed through sensitivity analysis. Results 1. The immunization prevention strategy of hepatitis B in the population over 15 years old in China was better than direct inoculation after screening. The BCR inoculated after screening were all greater than 1, and the BCR inoculated directly were all less than 1.2. The best vaccination strategy for hepatitis B vaccination in China aged 15 years and above was to screen 3 items (anti-HBc) and then inoculate 10 渭 g hepatitis B vaccine according to 0-1-6 months program. The BCR of the best scheme for 15-19 years old group is 2.40. For each investment of 1229.59 yuan, it can produce 2950.75 yuan benefit and 1721.16 yuan net benefit. The BCR of the best scheme for 20-29 years old group is 3.22. For every investment of 862.56 yuan, the net benefit of 2774.04 yuan can be obtained. The BCR of the best scheme for 30-39 years old group is 3.81, with 680.09 yuan per investment, 2591.16 yuan net benefit is 1191.07 yuan net benefit. The best scheme for 40-49 years old group is 3.98. For each investment of 5421.81 yuan, the net benefit of 2157.92 yuan benefit is 1615.12 yuan. The BCR of the best scheme for the group over 50 years old is 3.22, that is, the net benefit of 935.20 yuan can be obtained for every 290.16 yuan invested. The ratio of benefit to cost of each age group increases with age, but the total benefit is getting lower and lower. The results suggest that investing in the lower age group will result in greater social benefits. 3 according to the various programs of hepatitis B immunization prevention, The decision tree-Markov model is established and the method of cost-benefit analysis is used to evaluate the merits and demerits of each scheme with BCR as the evaluation index. That is to say, the decision tree-Markov model has good applicability and reliability for quantification of hepatitis B immune prevention strategy. The sensitivity of the model to each parameter is HBVM positive rate in turn. Vaccination coverage rate, anti-HBs positive conversion rate after vaccination, vaccine and inoculation fee, screening fee, discount rate and HBV infection cost. 5 whether the invisible cost of HBV infection cost was added or not had no effect on the optimal selection order of HBV vaccination strategy for the time being. Conclusion 1. Vaccination after screening is better than direct inoculation in the population over 15 years of age in China. The best inoculation scheme was to screen 3 items (anti-HBs, HBsAg, anti-HBc) and then inoculate 10 渭 g hepatitis B vaccine according to the procedure of 0-1-6 months. 2. The decision tree Markov model was constructed to prevent hepatitis B in the population over 15 years of age in China. The quantitative optimization has good applicability and reliability. 3. The positive rate of HBVM has been found in the parameters that have a great influence on the model. Vaccination rate and positive rate of anti-HBs after vaccination, and cost of vaccine and inoculation, screening cost, The discount rate and the cost of HBV infection had little effect on the model. 4. It was not found that the invisible cost of HBV infection cost had influence on the selection sequence of hepatitis B vaccination program.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類(lèi)號(hào)】：R392.1
【引證文獻(xiàn)】
相關(guān)期刊論文 前1條
1 張吉?jiǎng)P;鄭慧貞;梁劍;夏艷輝;;甲肝減毒活疫苗納入廣東省擴(kuò)大免疫規(guī)劃項(xiàng)目成本-效益分析[J];中國(guó)衛(wèi)生經(jīng)濟(jì);2013年07期
相關(guān)博士學(xué)位論文 前2條
1 朱大偉;使用者付費(fèi)下農(nóng)村地區(qū)成人乙肝疫苗利用、需求和接種機(jī)構(gòu)選擇研究[D];山東大學(xué);2013年
2 呂靜靜;山東省新生兒乙肝疫苗免疫策略經(jīng)濟(jì)學(xué)評(píng)價(jià)研究[D];山東大學(xué);2013年
，本文編號(hào)：2135164
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