摘要
目的比较中国住院患者采用乙型和丙型肝炎核酸筛查、免疫学筛查和无筛查策略时不同支付意愿(WTP)下的成本效果,探索最优策略。方法以核酸筛查、免疫学筛查和无筛查为研究策略,2021年我国国内生产总值(GDP)80976元为WTP阈值,构建马尔可夫模型。引入住院患者乙型和丙型肝炎诊断治疗相关参数后,采用TreeAge Pro 2021软件创建以10万例住院患者作为模拟队列的决策树模型,计算不同筛查策略的总成本、总效果、增量成本效果比和平均成本效果比,进行成本效果比较和评估。采用单因素和概率敏感性分析用于评估参数不确定性对最终结果的影响。结果相对无筛查策略,对队列患者乙型肝炎免疫学筛查策略增量总成本为11049536元,增量成本效果比为24762元/质量调整寿命年(QALY),而核酸筛查获得增量总成本19208059元,增量成本效果比为29873元/QALY;核酸与免疫学筛查比较增量成本效果比为45834元/QALY。相对无筛查策略,丙型肝炎免疫学筛查策略增量成本效果比为5731元/QALY,核酸筛查策略增量成本效果比为8722元/QALY,核酸筛查与免疫学筛查的增量效果比为45591元/QALY。概率敏感性分析结果显示,当核酸检测费用超过214.53元时,在1倍GDP的WTP值下进行乙型肝炎核酸筛查不具有成本效果。当核酸检测费用超过132.18元时,在1倍GDP的WTP值下进行丙型肝炎筛查不具有成本效果。结论核酸筛查策略能获得更多的成本效果。与对住院患者乙型和丙型肝炎无筛查策略比较,无论是核酸筛查还是免疫学筛查策略均具有成本效果。
Objective To compare the cost-effectiveness of hospitalized Chinese patients undergoing nucleic acid screening strategies for hepatitis B and hepatitis C,immunological screening strategy,and no screening strategy under different willingness to pay(WTP).The results might aid to decision-making for the optimal strategy.Methods In this study,nucleic acid screening,immunological screening and no screening were used as screening strategies,and China′s GDP in 2021(80976 yuan)was used as the threshold of WTP to construct a Markov model.After introducing parameters related to the diagnosis and treatment of hepatitis B and C in inpatients,a cohort population of 100000 inpatients was simulated by TreeAge Pro 2021 software,the total cost,total health effects,incremental cost-effectiveness ratio and average cost-effectiveness ratio of different screening strategies were calculated,and cost-effectiveness analysis was conducted.Univariate and probabilistic sensitivity analysis were used to assess the impact of parameter uncertainty on the final results.Results Compared with the non-screening strategy,the incremental total cost of the hepatitis B immunological screening strategy for cohort patients was 11049536 yuan,and the incremental cost-effectiveness ratio was 24762 yuan/quality-adjusted life years(QALY),while the total incremental cost of nucleic acid screening was 19208059 yuan,and the incremental cost-effectiveness ratio was 29873 yuan/QALY;the incremental cost-effectiveness ratio of nucleic acid screening and immunological screening was 45834 yuan/QALY.Compared with the non-screening strategy,the incremental cost-effectiveness ratio of hepatitis C immunological screening strategy was 5731 yuan/QALY,the incremental cost-effectiveness ratio of nucleic acid screening strategy was 8722 yuan/QALY,the incremental cost-effectiveness ratio of nucleic acid screening and immunological screening was 45591 yuan/QALY.The results of probabilistic sensitivity analysis showed that when the cost of nucleic acid testing exceeded 214.53
作者
苏舒
张琦
王鹏
桂嵘
杜春红
李喜莹
吕先萍
夏荣
刘凤华
秦莉
牛佳萌
邢莉莉
张蕾蕾
马金旗
胡俊华
张元
蔡鹃
靳慧芳
张俊
曹荣祎
宫济武
杨江存
Shu Su;Qi Zhang;Peng Wang;Rong Gui;Chunhong Du;Xiying Li;Xianping Lyu;Rong Xia;Fenghua Liu;Li Qin;Jiameng Niu;Lili Xing;Leilei Zhang;Jinqi Ma;Junhua Hu;Yuan Zhang;Juan Cai;Huifang Jin;Jun Zhang;Rongyi Cao;Jiwu Gong;Jiangcun Yang(Department of Blood Transfusion,Shaanxi Provincial People′s Hospital,Xi'an 710068,China;Department of Blood Transfusion,Huashan Hospital Fudan University,Shanghai 200040,China;Department of Blood Transfusion,Peking University First Hospital,Beijing 100034,China;Department of Blood Transfusion,the Third Xiangya Hospital of Central South University,Changsha 410013,China;Department of Blood Transfusion,Tianjin Medical University General Hospital,Tianjin 300052,China;Department of Blood Transfusion,Cancer Hospital Chinese Academy of Medical Sciences,Beijing 100021,China;Department of Blood Transfusion,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Blood Transfusion,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China;Department of Blood Transfusion,West China Hospital Sichuan University,Chengdu 610041,China;Department of Blood Transfusion,Beijing Hospital,Beijing 100730,China)
出处
《中华检验医学杂志》
CAS
CSCD
北大核心
2023年第1期38-44,共7页
Chinese Journal of Laboratory Medicine
关键词
病毒性肝炎
核酸
筛查
成本-效果分析
Hepatitis
Nucleic acid amplification techniques
Screening
Cost-effectiveness analysis
