摘要
目的综合各种HBV母婴传播阻断的影响因素，评价母婴传播阻断方案成本效益并明确其优选方案。方法构建符合中国实际的HBV母婴传播阻断策略决策树马尔科夫模型（其中参数依据Meta分析、现场调查和文献查阅等方法确定）；HBV母婴传播阻断方案的优化指标包括总成本、总效益、净效益值及效益成本比（BCR），并对模型中的参数对优化方案的影响进行敏感性分析。结果针对中国现阶段6种可能的HBV母婴传播阻断方案，构建了多级决策树模型；分别考虑了HBsAg和HBeAg筛检、不同剂量（次）乙型肝炎（乙肝）疫苗和免疫球蛋白（HBIG）的选用情况。6种方案的BCR均大于l，可获得的效益均超过成本至少4倍。各方案中以孕妇筛查HBsAg，HBsAg阳性新生儿接种10ggX3乙肝疫苗加一剂100IUHBIG，HBsAg阴性新生儿接种10gg×3乙肝疫苗的方案最优。HBV母婴传播阻断方案中，采用100IU或200IU的HBIG，其BCR相近；采用1剂次HBIG（100IU或200Iu）其BCR均高于2剂次。敏感性分析显示，参数对优化方案的影响大小依次为接种率、母婴传播阻断率、HBsAg阳性率、乙肝相关疾病经济负担、贴现率、接种费和筛检费，其中接种率和阻断率为HBV母婴传播阻断优化方案中最重要的影响因素。结论孕妇筛检HBsAg，新生儿采用10嵋乙肝疫苗联合looIu的HBIG是HBV母婴传播阻断的最优方案；方案中的接种率和阻断效率，是确保HBV母婴传播阻断的关键。
Objective To synthesize relevant data and to analyze the benefit-cost ratio on strategies related to preventing the maternal-infantile transmission of hepatitis B virus infection and to explore the optimal strategy. Methods A decision tree model was constructed according to the strategies of hepatitis B immunization and a Markov model was conducted to simulate the complex disease progress after HBV infection. Parameters in the models were drawn from meta-analysis and information was collected from field study and review of literature. Economic evaluation was performed to calculate costs, benefit, and the benefit-cost ratio. Sensitivity analysis was also conducted and a tornado graph was drawn. Results In view of the current six possible strategies in preventing maternal-infantile transmission of hepatitis B virus infection, a multi-stage decision tree model was constructed to screen hepatitis B surface antigen （HBsAg） or screen for HBsAg then hepatitis B e antigen （HBeAg）. Dose and the number of injections of HBIG and hepatitis B vaccine were taken into consideration in the model. All the strategies were considered to be cost-saving, while the strategy of screening for HBsAg and then offering hepatitis B vaccine of 10 μg X 3 for all neonates with hepatitis B immunoglobulin （HBIG） of 100 IU 1 for the neonates born to mothers who tested positive for HBsAg appeared with most cost-saving. In the strategies, the benefit-cost ratio of using 100 IU HBIG was similar to 200 IU HBIG, and one shot of HBIG was superior to two shots. Results from sensitivityanalysis suggested that the rates of immunization and the efficacy of the strategy in preventing maternal-infantile transmission were the main sensitive variables in the model. Conclusion The passive-active immune-prophylaxis strategy that using 10μg hepatitis B vaccine combined with 1 O0 IU HBIG seemed to be the optimal strategy in preventing maternal-infantile transmission, while the rates of immunization and the efficacy of the strategy played the key roles in choosing the ideal strategy.
出处
《中华流行病学杂志》
CAS
CSCD
北大核心
2013年第3期273-278,共6页
Chinese Journal of Epidemiology
