本文選題：艾滋病　切入點：檢測　出處：《中國疾病預(yù)防控制中心》2013年博士論文　論文類型：學(xué)位論文

【摘要】：目的：對調(diào)查地區(qū)的艾滋病檢擴大測策略進行衛(wèi)生經(jīng)濟學(xué)評價,分析其成本-效果和成本效用,為衛(wèi)生決策部門以后因地制宜的實施或調(diào)整該策略提供科學(xué)依據(jù)。 方法：本研究包括兩個部分,第一部分是以現(xiàn)場調(diào)查為基礎(chǔ),旨在調(diào)查選定地區(qū)自2006年至2011年底HIV檢測策略的實施情況,測算該地區(qū)的HIV擴大檢測策略的逐年成本投入和總成本投入,收集該地區(qū)逐年的檢測人次數(shù)、檢測陽性數(shù)以及納入管理的陽性人數(shù)；第二部分為利用Bernoulli-process模型計算因性傳播途徑所避免的新發(fā)感染人數(shù)以及因注射吸毒感染途徑而避免的新發(fā)感染人數(shù)。此外,通過構(gòu)建Markov模型模擬計算獲得的質(zhì)量調(diào)整生命年,利用上述數(shù)據(jù)對廣州市2006-2011年HIV檢測策略進行成本-效果分析和成本-效用分析。 結(jié)果：廣州市2006-2011年HIV檢測策略總的成本投入呈逐年上升趨勢,總成本為14849.247萬元；2006年總成本投入為1670.483萬元,而2011年則上升為3845.237萬元。 對廣州市HIV檢測策略進行成本-效果分析,以每新發(fā)現(xiàn)一例HIV陽性感染者作為效果指標,廣州市2006-2011年的平均成本-效果比為1.380萬元/每發(fā)現(xiàn)1例HIV感染者；以每將一例陽性病人進納入到管理體系中作為效果指標,近6年的平均成本-效果比為1.612萬元／每納入1例HIV感染者；以每避免一例HIV陽性感染者作為效果指標,則近6年平均每避免一例新發(fā)感染需要花費約為12.703萬元,波動范圍為1.802萬元-62.131萬元；通過分析廣州市接受HIV檢測的人群中HIV血清陽性率與成本-效果比關(guān)系得出,隨著HIV血清陽性率的降低,每發(fā)現(xiàn)一例HIV感染者的成本上升。 對廣州市HIV檢測策略進行成本-效用分析,結(jié)果發(fā)現(xiàn)：廣州市HIV檢測措施實施后,若不考慮對HIV感染者隨訪治療等費用,則每挽救一個QALY需花費0.221萬元；在考慮對HIV感染者/AIDS病人的隨訪治療費用的前提下,每挽回一個QALY需要花費1.574萬元。 結(jié)論：廣州市HIV檢測策略的實施是符合成本效益原則的,應(yīng)在現(xiàn)有HIV檢測策略實施的基礎(chǔ)上,進一步擴大HIV檢測覆蓋面,并加強對重點人群的篩查,以發(fā)現(xiàn)更多潛在的HIV感染者。但研究僅調(diào)查了廣州地區(qū)的數(shù)據(jù),仍然缺乏不同流行水平和不同經(jīng)濟水平地區(qū)的相關(guān)證據(jù)。應(yīng)根據(jù)HIV不同流行水平和當(dāng)?shù)夭煌慕?jīng)濟水平,開展HIV檢查策略的衛(wèi)生經(jīng)濟學(xué)評價。
[Abstract]:Objective: to evaluate the strategy of expanding HIV / AIDS testing in the investigation area, analyze its cost effect and cost utility, and provide a scientific basis for the implementation or adjustment of the strategy in accordance with the local conditions in the future. Methods: this study consists of two parts. The first part is based on the field investigation. The purpose of this study is to investigate the implementation of HIV detection strategy in selected areas from 2006 to end of 2011. The annual cost input and total cost input of the expanded HIV detection strategy in this area were calculated, and the number of person-times tested, the number of positive people tested and the number of positive people brought into the management were collected year by year in this area. The second part is to calculate the number of new infections avoided by the route of sexual transmission and the number of new infections avoided by the route of injecting drug use using the Bernoulli-process model. In addition, the quality-adjusted life years obtained by constructing the Markov model are simulated and calculated. The above data are used to analyze the cost-effect and cost-utility of HIV detection strategy in Guangzhou from 2006 to 2011. Results: from 2006 to 2011, the total cost of HIV detection strategy in Guangzhou increased year by year, with the total cost of one hundred and forty-eight million four hundred and ninety-two thousand and four hundred and seventy yuan, sixteen million seven hundred and four thousand and eight hundred and thirty yuan in 2006 and thirty-eight million four hundred and fifty-two thousand and three hundred and seventy yuan in 2011. The cost-effect analysis of HIV detection strategy in Guangzhou was carried out. The average cost-effect ratio between 2006 and 2011 was 13,800 yuan per case of HIV infection. Taking each positive patient into the management system as an effect indicator, the average cost-effect ratio of nearly 6 years was 16,120 yuan per case of HIV infection, and one case of HIV positive infection was avoided as an effect index. The average cost of avoiding a new infection in the past 6 years was about 127,030 yuan, with a fluctuation range of 18,020 yuan to 621,310 yuan. The relationship between the positive rate of HIV serum and the cost-effectiveness ratio among the people who were tested for HIV in Guangzhou City was analyzed. As the HIV seropositive rate decreases, the cost of each case of HIV infection increases. The cost-utility analysis of HIV detection strategy in Guangzhou was carried out. The results showed that if the cost of follow-up treatment for HIV infected persons was not considered, it would cost 2,210 yuan to save a QALY after the implementation of HIV detection measures in Guangzhou; After considering the cost of follow-up treatment for patients with HIV / AIDS, it costs $15,740 for each QALY to be recovered. Conclusion: the implementation of HIV detection strategy in Guangzhou is in line with the principle of cost-effectiveness. Based on the implementation of the existing HIV detection strategy, the coverage of HIV detection should be further expanded, and the screening of key population should be strengthened. In order to find more potential HIV infections, however, the study only investigated data from Guangzhou, and still lacked relevant evidence for different epidemic levels and different economic levels. Different HIV prevalence levels and different local economic levels should be taken into account. To evaluate the health economics of HIV inspection strategy.
【學(xué)位授予單位】：中國疾病預(yù)防控制中心
【學(xué)位級別】：博士
【學(xué)位授予年份】：2013
【分類號】：R512.91

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