艾滋病單陽家庭不同抗病毒治療策略成本、效果及效用研究
發(fā)布時間：2018-08-14 13:33
【摘要】：背景：自2003年,為響應國家“四免一關懷”的號召,各地積極推進艾滋病抗病毒治療(Antiretroviral Treatment ART)工作,并逐年擴大覆蓋面。隨著國家免費ART起始治療標準的逐步提高,不同ART策略的HIV單陽家庭HIV/AIDS患者的生命質量,抗病毒治療的效果,以及成本-效果和成本-效用情況,國內尚未見有關的研究和報導。目的：通過了解調查地區(qū)HIV單陽家庭HIV/AIDS患者生命質量、艾滋病ART情況及影響因素,評價HIV單陽家庭HIV/AIDS生命質量和接受艾滋病ART的效果；探討調查地區(qū)HIV單陽家庭不同ART策略的成本,成本效果,成本-效用,為下一步擴大艾滋病ART預防HIV傳播的策略提供依據(jù),為決策部門今后因地制宜地實施和調整該策略提供科學依據(jù)。方法：第一部分以現(xiàn)場調查為基礎,選擇河南省周口市HIV單陽家庭HIV/AIDS患者為研究對象,通過2015年1-5月現(xiàn)場問卷調查,并與調查地區(qū)艾滋病疫情數(shù)據(jù)庫回顧性分析相結合的方法收集HIV單陽家庭HIV/AIDS患者的基本特征、生命質量、艾滋病ART直接醫(yī)療成本和直接非醫(yī)療成本、調查地區(qū)配偶轉陽率、不同ART策略研究期間的累計生存時間、病毒載量(VL)完全抑制率和CD4+T淋巴細胞(簡稱CD4細胞)增長率效果指標,開展不同ART策略成本-效果分析；第二部分為通過構建Markov模型并模擬計算獲得質量調整生命年,對HIV單陽家庭HIV/AIDS患者早期和常規(guī)接受艾滋病ART策略進行成本-效用分析。結果：根據(jù)調查地區(qū)接受ART治療后各類直接醫(yī)療費用和直接非醫(yī)療費用年人均單價,結合當?shù)谻PI各年漲跌比率,測算出調查地區(qū)2,271例HIV單陽家庭HIV/AIDS患者接受ART治療2004-2015年總成本為30,832.91萬。不同CD4細胞起始ART的總成本分別為：CD4細胞≤200個/mm3組12,177.87萬,201～350個/mm3組10,470.85萬,351～500個/mm3組4,680.31萬,500個/mm3組3,503.88萬；各組每人年費用分別為2.13萬元、2.42萬元、2.14萬元及1.96萬元,其中,CD4細胞500個/mm3組每人年費用最低。通過方差分析,4組HIV單陽家庭HIV/AIDS患者除二線藥物費用外,其它類別抗病毒治療相關成本差異均有統(tǒng)計學意義(P0.01)。對調查地區(qū)HIV單陽家庭HIV/AIDS患者不同ART策略成本-效果分析,以不同ART策略累計生存時間作為效果指標,成本-效果比最低的為CD4細胞≤200個/mm3策略的2.13萬元/生命年,而CD4細胞500個/mm3組成本-效果比僅高于CD4細胞≤200個/mm3策略為2.20萬元/生命年,且與CD4細胞≤200個/mm3策略比,CD4細胞500個/mm3策略增量成本效果比(ICER)最小,每多獲得1個生存年的花費2.25萬元；以配偶未陽轉率作為效果指標,成本-效果比最低為CD4細胞≤200個/mm3策略122.34萬元,而成本-效果比最高的為CD4細胞500個/mm3策略309.54萬元,與CD4細胞≤200個/mm3策略相比,CD4細胞500個/mm3策略ICER最小,表示每多獲得1/100人年配偶未陽轉率比CD4細胞≤200個/mm3策略少花費3.33萬元；以各年VL完全抑制率作為效果指標,不同ART策略VL完全抑制率存在波動,各檢測時段CD4細胞≤200個/mm3策略成本-效果比最低,CD4細胞500個/mm3策略成本-效果比僅高于CD4細胞≤200個/mm3策略,且在接受ART第1、2、6年均低于CD4細胞≤350個/mm3和CD4細胞≤500個/mm3策略；以每年CD4細胞增長率作為效果指標,CD4細胞≤200個/mm3策略成本-效果比各檢測時段均最低,CD4500個/mm3策略在接受ART第1年成本-效果比最高,隨后均為CD4細胞≤500個/mm3策略成本-效果比最高。與CD4細胞≤200個/mm3策略相比,CD4細胞≤350個/mm3策略ICER最小。對調查地區(qū)HIV單陽家庭HIV/AIDS患者艾滋病ART策略成本-效果分析,首先開展了現(xiàn)場生命質量調查,結果為河南周口市單陽家庭HIV/AIDS在生理領域、心理領域、社會關系領域和環(huán)境領域的得分分別為(12.00±2.02)、(12.07±2.07)、(11.87±1.99)和(11.09±1.84)分。周口市艾滋病患者生理、心理、社會關系和環(huán)境4個領域得分與常模(15.10±2.30)、(13.89±1.89)、(13.93±2.06)和(12.14±2.08)分比較,各領域得分與常模差異均有統(tǒng)計學意義(P0.01)。浙江臺州市HIV/AIDS在生理領域、心理領域、社會關系領域和環(huán)境領域的得分分別為(14.99±2.25)、(14.25±2.12)、(13.22±2.37)、(13.31±1.99)。4個領域得分與常模比較,除環(huán)境領域得分與常模存在顯著性差異外(P0.05),其它領域均無統(tǒng)計學意義。周口市單陽家庭在生理領域、心理領域、社會關系領域和環(huán)境領域的得分均低于臺州市單陽家庭在生理領域、心理領域、社會關系領域和環(huán)境領域的得分(14.76±2.43)、(14.07±2.16)、(13.07±2.24)和(13.07±1.97),差異均有統(tǒng)計學意義(P0.01)。成本-效用分析結果發(fā)現(xiàn)：調查地區(qū)常規(guī)艾滋病ART策略(CD4細胞≤350個/mm3),則每獲得一個QALY需花費2.96萬元,早期艾滋病ART策略(CD4細胞350個/mm3),則每獲得一個QALY需花費3.18萬元,且相對于常規(guī)ART策略,早期ART策略的ICUR為6.48,即每多獲得1個QALY需多花費6.48萬元。按WHO標準,早期和常規(guī)艾滋病ART策略均符合成本效益原則。結論：調查地區(qū)針對HIV單陽家庭HIV/AIDS患者實施早期艾滋病ART策略,不僅擴大了艾滋病ART服務覆蓋面,延長HIV/AIDS患者壽命,并且降低了配偶HIV陽轉比例,成本-效果明顯：按WHO標準,成本-效用分析結果符合成本效益原則。
[Abstract]:BACKGROUND: Since 2003, in response to the call of "four exemptions and one care" of the state, anti-retroviral treatment (ART) has been actively promoted and expanded year by year. Objective: To evaluate the quality of life (QOL) of HIV / AIDS patients in single-positive families and the effect of HIV / AIDS ART on their acceptance of AIDS ART by demodulating the quality of life (QOL), AIDS ART and influencing factors of HIV / AIDS patients in single-positive families. The cost, cost-effectiveness and cost-effectiveness of different ART strategies for HIV single-positive families provide the basis for further expanding the strategy of AIDS ART to prevent HIV transmission, and provide scientific basis for decision-making departments to implement and adjust the strategy in accordance with local conditions in the future. The basic characteristics, quality of life, ART direct medical costs and direct non-medical costs of HIV/AIDS patients in single-positive families were collected through on-the-spot questionnaires conducted from January to May 2015 and retrospective analysis of the AIDS epidemic database in the investigated areas. The cumulative survival time, viral load (VL) complete inhibition rate and CD4 + T lymphocyte (CD4 cell) growth rate during the strategy study were used to analyze the cost-effectiveness of different ART strategies. The second part was to construct Markov model and simulate the quality-adjusted life year for HIV/AIDS patients in single-positive families. Results: According to the annual per capita price of direct medical expenses and direct non-medical expenses after ART treatment in the survey area, combined with the local CPI rate of rise and fall in each year, the total cost of ART treatment for 2,271 HIV/AIDS patients in single-positive families in the survey area was estimated to be 30,832 in 2004-2015. The total cost of ART initiation for different CD4 cells was 127.787 million in the group of <200/mm 3, 1047.85million in the group of 201-350/mm 3, 46.8031 million in the group of 351-500/mm 3 and 35.038 million in the group of 500/mm 3, respectively; the annual cost for each group was 21.13 million yuan, 24.2 million yuan, 21.14 million yuan and 19.96 million yuan, respectively. Cost-effectiveness analysis of different ART strategies for HIV/AIDS patients in single-positive families was conducted. The cumulative survival time of different ART strategies was taken as the effect index. The lowest cost-effectiveness ratio was 21.3 million yuan per life year for CD4 cells (< 200 / mm3) strategy, whereas the cost-effectiveness ratio of CD4 cells (< 200 / mm3) strategy was only higher than that of CD4 cells (< 200 / mm3) strategy. Compared with CD4 cells (< 200 / mm3) strategy, the incremental cost-effectiveness ratio (ICER) of CD4 cells (< 500 / mm3) strategy was the smallest. The lowest cost-effectiveness ratio was CD4 cells (< 200 / mm3) strategy 1.2234 million yuan, and the highest cost-effectiveness ratio was CD4 cells (< 500 / mm3) strategy 3.0954 million yuan. Compared with CD4 cells (< 200 / mm3) strategy, CD4 cells (< 500 / mm3) strategy ICER was the smallest, indicating that every additional gain was 1/10. The total inhibition rate of VL by different ART strategies fluctuated, and the cost-effectiveness ratio of CD4 cells less than 200/mm3 strategies was the lowest in each detection period, and that of CD4 cells less than 500/mm3 strategies was only higher than that of CD4 cells less than 200 cells less than that of CD4 cells less than that of CD4 cells less than 200/mm3 strategies. The cost-effectiveness ratio of CD4 cells < 200/mm3 strategy was the lowest in each test period, and the cost-effectiveness ratio of CD4 500/mm3 strategy was the highest in the first year of ART, followed by CD4 fine. Compared with CD4 cell < 200 cell / mm3 strategy, CD4 cell < 350 cell / mm3 strategy ICER is the smallest. To analyze the cost - effectiveness of HIV / AIDS ART strategy in HIV / AIDS single-positive families in the investigation area, the field quality of life survey was carried out, and the results showed that HIV / AIDS in single-positive families in Zhoukou City, Henan Province was in physiology. Scores in physical, psychological, social and environmental fields of AIDS patients in Zhoukou were (15.10 [2.30], (13.89 [1.89], (13.93 [2.06] and (12.14 [2.08], respectively. The scores of HIV/AIDS in physiological, psychological, social and environmental fields were (14.99 2.25), (14.25 2.12), (13.22 2.37), (13.31 1.99). Compared with the norm, the scores of HIV/AIDS in four fields were (14.99 2.25), (14.25 2.12, (13.22 2.37), (13.31 1.99). Except for the The scores in physiological, psychological, social and environmental fields of single-yang families in Zhoukou City were lower than those in physiological, psychological, social and environmental fields of Taizhou City (14.76 + 2.43), 14.07 + 2.16, 13.07 + 2.24 and 13.07 + 1.97). Cost-utility analysis showed that the cost of acquiring a QALY was 29.6 million yuan for the conventional ART strategy (CD4 cells < 350/mm3) and 31.8 million yuan for the early ART strategy (CD4 cells 350/mm3). According to WHO standards, early and conventional ART strategies for HIV/AIDS patients in single-positive families in the survey area are cost-effective. Conclusion: The implementation of early AIDS ART strategy for HIV/AIDS patients in single-positive families not only enlarges the coverage of AIDS ART services, prolongs the life span of HIV/AIDS patients, but also reduces the cost-effectiveness. According to WHO standard, the cost-effectiveness analysis results accord with the cost-benefit principle.
【學位授予單位】：中國疾病預防控制中心
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R512.91
本文編號：2183017
[Abstract]:BACKGROUND: Since 2003, in response to the call of "four exemptions and one care" of the state, anti-retroviral treatment (ART) has been actively promoted and expanded year by year. Objective: To evaluate the quality of life (QOL) of HIV / AIDS patients in single-positive families and the effect of HIV / AIDS ART on their acceptance of AIDS ART by demodulating the quality of life (QOL), AIDS ART and influencing factors of HIV / AIDS patients in single-positive families. The cost, cost-effectiveness and cost-effectiveness of different ART strategies for HIV single-positive families provide the basis for further expanding the strategy of AIDS ART to prevent HIV transmission, and provide scientific basis for decision-making departments to implement and adjust the strategy in accordance with local conditions in the future. The basic characteristics, quality of life, ART direct medical costs and direct non-medical costs of HIV/AIDS patients in single-positive families were collected through on-the-spot questionnaires conducted from January to May 2015 and retrospective analysis of the AIDS epidemic database in the investigated areas. The cumulative survival time, viral load (VL) complete inhibition rate and CD4 + T lymphocyte (CD4 cell) growth rate during the strategy study were used to analyze the cost-effectiveness of different ART strategies. The second part was to construct Markov model and simulate the quality-adjusted life year for HIV/AIDS patients in single-positive families. Results: According to the annual per capita price of direct medical expenses and direct non-medical expenses after ART treatment in the survey area, combined with the local CPI rate of rise and fall in each year, the total cost of ART treatment for 2,271 HIV/AIDS patients in single-positive families in the survey area was estimated to be 30,832 in 2004-2015. The total cost of ART initiation for different CD4 cells was 127.787 million in the group of <200/mm 3, 1047.85million in the group of 201-350/mm 3, 46.8031 million in the group of 351-500/mm 3 and 35.038 million in the group of 500/mm 3, respectively; the annual cost for each group was 21.13 million yuan, 24.2 million yuan, 21.14 million yuan and 19.96 million yuan, respectively. Cost-effectiveness analysis of different ART strategies for HIV/AIDS patients in single-positive families was conducted. The cumulative survival time of different ART strategies was taken as the effect index. The lowest cost-effectiveness ratio was 21.3 million yuan per life year for CD4 cells (< 200 / mm3) strategy, whereas the cost-effectiveness ratio of CD4 cells (< 200 / mm3) strategy was only higher than that of CD4 cells (< 200 / mm3) strategy. Compared with CD4 cells (< 200 / mm3) strategy, the incremental cost-effectiveness ratio (ICER) of CD4 cells (< 500 / mm3) strategy was the smallest. The lowest cost-effectiveness ratio was CD4 cells (< 200 / mm3) strategy 1.2234 million yuan, and the highest cost-effectiveness ratio was CD4 cells (< 500 / mm3) strategy 3.0954 million yuan. Compared with CD4 cells (< 200 / mm3) strategy, CD4 cells (< 500 / mm3) strategy ICER was the smallest, indicating that every additional gain was 1/10. The total inhibition rate of VL by different ART strategies fluctuated, and the cost-effectiveness ratio of CD4 cells less than 200/mm3 strategies was the lowest in each detection period, and that of CD4 cells less than 500/mm3 strategies was only higher than that of CD4 cells less than 200 cells less than that of CD4 cells less than that of CD4 cells less than 200/mm3 strategies. The cost-effectiveness ratio of CD4 cells < 200/mm3 strategy was the lowest in each test period, and the cost-effectiveness ratio of CD4 500/mm3 strategy was the highest in the first year of ART, followed by CD4 fine. Compared with CD4 cell < 200 cell / mm3 strategy, CD4 cell < 350 cell / mm3 strategy ICER is the smallest. To analyze the cost - effectiveness of HIV / AIDS ART strategy in HIV / AIDS single-positive families in the investigation area, the field quality of life survey was carried out, and the results showed that HIV / AIDS in single-positive families in Zhoukou City, Henan Province was in physiology. Scores in physical, psychological, social and environmental fields of AIDS patients in Zhoukou were (15.10 [2.30], (13.89 [1.89], (13.93 [2.06] and (12.14 [2.08], respectively. The scores of HIV/AIDS in physiological, psychological, social and environmental fields were (14.99 2.25), (14.25 2.12), (13.22 2.37), (13.31 1.99). Compared with the norm, the scores of HIV/AIDS in four fields were (14.99 2.25), (14.25 2.12, (13.22 2.37), (13.31 1.99). Except for the The scores in physiological, psychological, social and environmental fields of single-yang families in Zhoukou City were lower than those in physiological, psychological, social and environmental fields of Taizhou City (14.76 + 2.43), 14.07 + 2.16, 13.07 + 2.24 and 13.07 + 1.97). Cost-utility analysis showed that the cost of acquiring a QALY was 29.6 million yuan for the conventional ART strategy (CD4 cells < 350/mm3) and 31.8 million yuan for the early ART strategy (CD4 cells 350/mm3). According to WHO standards, early and conventional ART strategies for HIV/AIDS patients in single-positive families in the survey area are cost-effective. Conclusion: The implementation of early AIDS ART strategy for HIV/AIDS patients in single-positive families not only enlarges the coverage of AIDS ART services, prolongs the life span of HIV/AIDS patients, but also reduces the cost-effectiveness. According to WHO standard, the cost-effectiveness analysis results accord with the cost-benefit principle.
【學位授予單位】：中國疾病預防控制中心
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R512.91
【參考文獻】
相關期刊論文 前1條
1 王倩,金丕煥;Markov模型在衛(wèi)生經(jīng)濟評價的應用[J];中國衛(wèi)生統(tǒng)計;2000年02期
，本文編號：2183017
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