【摘要】：研究背景通過綜合母嬰阻斷策略,可以將艾滋病母嬰傳播率降低到2%以下,我國(guó)政府自2010年起,加大了對(duì)艾滋病母嬰阻斷項(xiàng)目的投入,約占艾滋病總防治經(jīng)費(fèi)的三分之一。針對(duì)艾滋病母嬰阻斷策略科學(xué)的經(jīng)濟(jì)學(xué)評(píng)價(jià),有助于了解該項(xiàng)策略投入產(chǎn)出的量化關(guān)系,為決策者配置資源提供可靠的證據(jù)和信息。研究目的分析評(píng)價(jià)我國(guó)艾滋病母嬰阻斷項(xiàng)目的成本效果,探索適合于我國(guó)目前經(jīng)濟(jì)發(fā)展水平的艾滋病母嬰阻斷策略。研究方法根據(jù)研究目的,采用文獻(xiàn)檢索、現(xiàn)場(chǎng)調(diào)查、專家咨詢等途徑收集各狀態(tài)轉(zhuǎn)移概率和成本數(shù)據(jù),在此基礎(chǔ)上建立Markov模型,設(shè)置三種不同母嬰阻斷策略,即綜合母嬰阻斷策略,臨產(chǎn)母嬰阻斷策略和無(wú)阻斷策略,模擬艾滋病發(fā)展的過程。進(jìn)行Markov隊(duì)列分析,綜合評(píng)價(jià)三種策略的成本效果,并計(jì)算增量成本效果；對(duì)關(guān)鍵變量進(jìn)行敏感度分析,判斷其對(duì)結(jié)果的影響程度；進(jìn)行Monte Carlo試驗(yàn)?zāi)M分析,評(píng)價(jià)成本效果及結(jié)果變異程度；進(jìn)行Monte Carlo概率敏感度分析,綜合估計(jì)參數(shù)不確定時(shí)的三個(gè)策略的成本效果。研究結(jié)果1.假設(shè)三個(gè)組分別有100,000例孕產(chǎn)婦,Markov隊(duì)列分析結(jié)果顯示,綜合母嬰阻斷策略,臨產(chǎn)母嬰阻斷策略和無(wú)阻斷策略總花費(fèi)和獲得的生命年分別為8,709,349元/2,952,659 QALYs,5,598,963元/2,952,176 QALYs和2,739,870元/2,949,932 QALYs。三個(gè)組的成本效果比分別為2.95,1.90和0.09。與無(wú)阻斷策略相比,綜合母嬰阻斷策略的增量成本效果比(Incremental Cost Effectiveness Ratio, ICER)為2,189元/QALY,臨產(chǎn)母嬰阻斷策略的增量成本效果比為1,274元/QALY。與臨產(chǎn)母嬰阻斷策略相比,綜合母嬰阻斷策略的增量成本效果比為6,439元/QALY。母嬰阻斷僅影響各個(gè)組的初始分布,與無(wú)阻斷相比,綜合母嬰阻斷策略阻止了72例HIV感染,臨產(chǎn)母嬰阻斷策略阻止了57例HIV感染。與無(wú)阻斷策略相比,綜合母嬰阻斷策略每挽救一個(gè)健康新生兒需要花費(fèi)約82,909元,臨產(chǎn)母嬰阻斷策略每挽救一個(gè)健康新生兒需要花費(fèi)50,160元。2.敏感度分析結(jié)果表明,隨著參數(shù)的變化,相比其他兩種策略,綜合母嬰阻斷策略的增量成本效果始終小于意愿支付值(Willingness To Pay,WTP),其中每挽救一個(gè)QALY所需的花費(fèi)隨著孕產(chǎn)婦HIV患病率的增長(zhǎng)而降低,隨著HIV感染者和AIDS患者疾病負(fù)擔(dān)逐漸增加,綜合母嬰阻斷策略的先期投入會(huì)被后期節(jié)省的花費(fèi)抵消,變?yōu)楣?jié)約成本的策略。3.當(dāng)抽樣次數(shù)為100,000次時(shí),Monte Carlo試驗(yàn)?zāi)M分析結(jié)果表明,綜合母嬰阻斷策略,臨產(chǎn)母嬰阻斷策略和無(wú)阻斷策略人均花費(fèi)和獲得的生命年分別為86.28元/29.50QALYs,57.34元/29.49 QALYs和29.15元/29.47QALYs,三組的成本效果比分別為2.93,1.94和0.99。臨產(chǎn)組和對(duì)照組的成本值變異程度較綜合組大。綜合母嬰阻斷組相對(duì)于對(duì)照組和臨產(chǎn)阻斷組的增量成本效果比分別為1,991元/QALY和5,351元/QALY,臨產(chǎn)組相對(duì)于對(duì)照組的ICER為1,210元/QALY,均小于預(yù)設(shè)的意愿支付值。4.當(dāng)抽樣樣本量為1,000時(shí),Monte Carlo概率敏感度分析結(jié)果表明,三個(gè)組的人均成本效果值分別為101.34元/29.57QALY,76.77元/29.56QALY和74.79元/29.55QALY.臨產(chǎn)組和對(duì)照組成本呈明顯右偏態(tài)分布。意愿支付曲線表明當(dāng)意愿支付限高于4,000元時(shí),綜合母嬰阻斷組能獲得最多的效果。研究結(jié)論本研究假設(shè)三種母嬰阻斷策略,發(fā)現(xiàn)綜合母嬰阻斷策略符合成本效果,其支出成本在可接受范圍內(nèi)。建議應(yīng)該繼續(xù)擴(kuò)大艾滋病母嬰阻斷項(xiàng)目的覆蓋面,在已覆蓋地區(qū),應(yīng)加強(qiáng)孕產(chǎn)婦宣傳教育,探索針對(duì)孕產(chǎn)婦人群宣教的有效模式,提高其知曉率,鼓勵(lì)早期檢測(cè)。
[Abstract]:Through the comprehensive mother-to-child blocking strategy, the mother-to-child transmission rate of AIDS can be reduced to less than 2%, and the Government of our country, since 2010, has increased the input to the mother-to-child blocking project of AIDS, accounting for about one-third of the total HIV/ AIDS prevention. According to the economic evaluation of the strategy of mother-to-child blocking of AIDS, it is helpful to understand the quantitative relation of input-output of the strategy and provide reliable evidence and information for the decision-maker's allocation of resources. The purpose of this study is to analyze and evaluate the cost effect of the mother-to-child blocking project in China, and to explore the mother-to-child blocking strategy suitable for the current level of economic development in China. according to the purpose of the research, the state transition probability and the cost data are collected by means of a literature search, a field investigation, an expert consultation and the like, a Markov model is established, and three different mother-to-child blocking strategies, namely, a comprehensive mother-to-child blocking strategy, are set up, The mother-to-child blocking strategy and the non-blocking strategy to simulate the development of AIDS. carrying out the Markov-based queue analysis, comprehensively evaluating the cost effect of the three strategies, and calculating the incremental cost effect; carrying out sensitivity analysis on the key variables, and judging the influence degree of the incremental cost; carrying out the Monte Carlo simulation analysis, and evaluating the cost effect and the result variation degree; The method carries out the Monte Carlo probability sensitivity analysis and the cost effect of the three strategies when the comprehensive estimation parameter is uncertain. Study Results 1. It is assumed that there are 100,000 pregnant women in three groups, and the results of the Markov cohort analysis show that the total cost of the comprehensive mother-to-child blocking strategy, the mother-to-child blocking strategy and the total cost of the non-blocking strategy are 8,709,349/ 2,952,659 QALYs, 5,598, 963-yuan/ 2,952,176 QALYs and 2,739,870 yuan/ 2,949,932 QALYs, respectively. The cost-effect ratio of the three groups was 2.95, 1.90 and 0.09, respectively. Compared with the non-blocking strategy, the incremental cost effect ratio (ICER) of the comprehensive mother-to-child blocking strategy is 2,189 yuan/ QALY, and the incremental cost effect ratio of the mother-to-child blocking strategy is 1,274 yuan/ QALY. Compared with the mother-to-child blocking strategy, the incremental cost-effect ratio of the comprehensive mother-to-child blocking strategy is 6,439 Yuan/ QALY. The mother-to-child blocking only affected the initial distribution of the individual groups, and the comprehensive mother-to-child blocking strategy prevented the 72 cases of HIV infection, and the mother-to-child blocking strategy prevented the 57 cases of HIV infection. In comparison with the non-blocking strategy, the comprehensive mother-to-child blocking strategy will take about 82,909 yuan to save a healthy newborn, and the child-to-child blocking strategy will cost a total of 50, 160. The sensitivity analysis results show that, with the change of the parameters, the incremental cost effect of the comprehensive mother-to-child blocking strategy is always less than the will-to-pay (WTP) compared to the other two strategies, in which the cost of every saving one QALY is reduced with the increase of the prevalence of the maternal HIV, With the gradual increase of the disease burden of people living with HIV and AIDS, the advance input of the comprehensive mother-to-child blocking strategy will be offset by the cost savings and become a cost-saving strategy. The results of the Monte Carlo simulation analysis show that the total cost of the comprehensive mother-to-child blocking strategy, the mother-to-child blocking strategy and the non-blocking strategy per capita is 86.28 yuan/ 295.50QALYs, 5734 yuan/ 295.49 QALYs and 295.15 yuan/ 297.47QALYs, respectively, and the cost effect ratio of the three groups is 2.93, 1.94 and 0.99, respectively. The cost value variation of the group and the control group was higher than that of the comprehensive group. The effect of the comprehensive mother-to-infant blocking group on the incremental cost of the control group and the temporary block group was 1, 991 Yuan/ QALY and 5,351 Yuan/ QALY, respectively, and the ICER of the temporary production group with respect to the control group was 1, 210 Yuan/ QALY, which was less than the preset will payment value. When the sample size of the sample is 1,000, the Monte Carlo probability sensitivity analysis results show that the average cost effect of the three groups is 101.34 Yuan/ 295.57QALY, 767.77 Yuan/ 295.56QALY and 74.79 Yuan/ 295.55QALY, respectively. The cost of the control group and the control group was significantly lower than that of the control group. The willingness to pay the curve shows that the comprehensive mother-to-child blocking group can achieve the most effect when the willingness to pay is higher than 4,000 yuan. The results of the study suggest that the three types of mother-to-child blocking strategies are in accordance with the cost effect, and the cost of expenditure is within the acceptable range. It is suggested that the coverage of the mother-to-child blocking project of AIDS should continue to be expanded. In the areas covered, the maternal and child education should be strengthened, the effective mode of education for pregnant and pregnant women should be explored, the awareness rate should be improved, and early detection should be encouraged.
【學(xué)位授予單位】：中國(guó)疾病預(yù)防控制中心
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R512.91

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