Article(id=1241522850213974730, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522846384583426, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202308343, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1692288000000, receivedDateStr=2023-08-18, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773931713870, onlineDateStr=2026-03-19, pubDate=1707494400000, pubDateStr=2024-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773931713870, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773931713870, creator=13701087609, updateTime=1773931713870, updator=13701087609, issue=Issue{id=1241522846384583426, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='3', pageStart='385', pageEnd='576', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773931712956, creator=13701087609, updateTime=1773931842201, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241523388544504301, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522846384583426, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241523388544504302, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522846384583426, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=484, endPage=488, ext={EN=ArticleExt(id=1241522851145110233, articleId=1241522850213974730, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Cost-effectiveness analysis of expanded HIV testing strategy in Luzhou city from 2018 to 2020, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the cost-effectiveness of the expanded HIV testing strategy in Luzhou from 2018 to 2020, and to provide a basis for implementing or adjusting the strategy according to local conditions.

Methods

The cost data of HIV testing institutions at all levels were collected by self-made cost collection tools, and the number of tested people and newly reported cases were obtained from China Disease Prevention and Control Information system. The number of potential HIV infections averted by the sexual transmission route was estimated using the Bernoulli-process model, and the cost-effectiveness ratio was analyzed.

Results

From 2018 to 2020, the cumulative investment cost of Luzhou city in the HIV expansion testing was 151.76 million yuan after discounting, and the average cost in the three years was 50.58 million yuan. A total of 5.60 million people received HIV test in the past three years, with 7 318 new cases detected, and the average cost was 27.1 yuan per test. According to the Bernoulli-process model, the number of new infections prevented by sexual transmission in Luzhou city was 545 (67-7 373). Cost effectiveness analysis showed that from 2018 to 2020, the cost for identifying each new HIV-infected person was 21 000 yuan, and 92 000 yuan (7 000- 755 000) for preventing each HIV infection.

Conclusion

The expanded HIV testing strategy implemented in Luzhou from 2018 to 2020 accords with the cost-effectiveness principle and has economic effects. The cost-effectiveness of testing varies greatly in different regions, so the expanded testing strategy should be implemented according to the epidemic situation of different regions.

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目的

分析2018—2020年泸州市HIV扩大检测策略的成本效果,为当地因地制宜实施或调整该策略提供依据。

方法

通过自制的成本收集工具收集各级HIV检测机构开展检测工作的成本信息,从中国疾病预防控制信息系统获取检测人次数和新报告病例数,利用Bernoulli-process模型估计性传播途径所避免的新发感染人数,以成本效果比为指标进行成本效果分析。

结果

2018—2020年泸州市在HIV扩大检测工作中累积投入成本贴现后为15 175.5万元,三年间平均成本为5 058.5万元。三年共有559.9万人次接受HIV检测,新发现病例7 318例,检测平均成本为27.1元/人次。经Bernoulli-process模型计算得到泸州市因性传播所避免的新发感染人数为545(67~7 373)人。成本效果分析显示,2018—2020年,检出1例HIV感染者的成本为2.1万元,避免1例HIV感染者的成本为9.2(0.7~75.5)万元。

结论

泸州市2018—2020年实施的HIV扩大检测策略符合成本效果原则,具有较好的经济性。各地开展检测的成本-效果差异较大,应根据各地疫情流行现状分类实施扩大检测策略。

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梁姝,E-mail:
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卓玛拉措(1991—),女,硕士,主管医师,研究方向:艾滋病防控

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Parameters in the Bernoulli-process model

, figureFileSmall=null, figureFileBig=null, tableContent=
参数符号参数意义
N调查人群数量
Pa目标人群参与率
p目标人群中HIV感染率
a目标人群每次性行为感染HIV的概率
e目标人群每次性行为中安全套有效率
f1未干预前,目标人群每次性行为中安全套的使用率
f2干预后,目标人群每次性行为中安全套的使用率
n目标人群的性生活次数/性伴/年
m目标人群的性伴数/年
z目标人群性伴重叠系数
), ArticleFig(id=1241680455548859128, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522850213974730, language=CN, label=表1, caption=

Bernoulli-process模型参数意义

, figureFileSmall=null, figureFileBig=null, tableContent=
参数符号参数意义
N调查人群数量
Pa目标人群参与率
p目标人群中HIV感染率
a目标人群每次性行为感染HIV的概率
e目标人群每次性行为中安全套有效率
f1未干预前,目标人群每次性行为中安全套的使用率
f2干预后,目标人群每次性行为中安全套的使用率
n目标人群的性生活次数/性伴/年
m目标人群的性伴数/年
z目标人群性伴重叠系数
), ArticleFig(id=1241680455674688255, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522850213974730, language=EN, label=Table 2, caption=

The cost of HIV testing in Luzhou city from 2018 to 2020 (ten thousand yuan) and its component ratio(%)

, figureFileSmall=null, figureFileBig=null, tableContent=
成本项目2018年2019年2020年合计年均成本
检测人力1 621.8(36.2)1 837.9(33.7)1 920.2(33.6)5 379.8(34.3)1 793.3(34.3)
检测试剂1 364.3(30.4)1 852.9(33.9)1 907.3(33.3)5 124.5(32.7)1 708.2(32.7)
一次性用品和耗材407.0(9.1)498.4(9.1)586.1(10.2)1 491.5(9.5)497.2(9.5)
房屋成本562.9(12.6)632.3(11.6)663.0(11.6)1 858.1(11.9)619.4(11.9)
固定资产519.1(11.6)634.5(11.6)643.8(11.3)1 797.4(11.5)599.1(11.5)
培训和督导7.2(0.2)2.2(0)2.3(0)11.7(0.1)3.9(0.1)
合计4 482.35 458.25 722.615 663.05 221.0
), ArticleFig(id=1241680455779545863, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522850213974730, language=CN, label=表2, caption=

2018—2020年泸州市HIV检测各项花费(万元)及构成比(%)

, figureFileSmall=null, figureFileBig=null, tableContent=
成本项目2018年2019年2020年合计年均成本
检测人力1 621.8(36.2)1 837.9(33.7)1 920.2(33.6)5 379.8(34.3)1 793.3(34.3)
检测试剂1 364.3(30.4)1 852.9(33.9)1 907.3(33.3)5 124.5(32.7)1 708.2(32.7)
一次性用品和耗材407.0(9.1)498.4(9.1)586.1(10.2)1 491.5(9.5)497.2(9.5)
房屋成本562.9(12.6)632.3(11.6)663.0(11.6)1 858.1(11.9)619.4(11.9)
固定资产519.1(11.6)634.5(11.6)643.8(11.3)1 797.4(11.5)599.1(11.5)
培训和督导7.2(0.2)2.2(0)2.3(0)11.7(0.1)3.9(0.1)
合计4 482.35 458.25 722.615 663.05 221.0
), ArticleFig(id=1241680455896986383, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522850213974730, language=EN, label=Table 3, caption=

Cost of HIV testing among counties of Luzhou city from 2018 to 2020 (ten thousand yuan)

, figureFileSmall=null, figureFileBig=null, tableContent=
地区投入成本贴现成本a
2018年2019年2020年合计年均成本2018年2019年2020年合计年均成本
市本级b1 169.21 442.41 457.84 069.41 356.51 169.21 400.41 374.13 943.71 314.6
江阳区237.9344.9369.6952.4317.5237.9334.8348.4921.1307.0
纳溪区430.2520.7584.41 535.4511.8430.2505.5550.91 486.6495.5
龙马潭区335.2439.0427.81 202.0400.7335.2426.2403.31 164.7388.2
泸县644.0820.9778.82 243.7747.9644.0797.0734.12 175.1725.0
合江县393.4486.9529.11 409.4469.8393.4472.8498.71 364.9455.0
叙永县641.6720.8745.22 107.7702.6641.6699.8702.52 043.9681.3
古蔺县630.7682.6829.72 143.0714.3630.7662.8782.12 075.5691.8
合计4 482.35 458.25 722.615 663.05 221.04 482.35 299.25 394.115 175.55 058.5
), ArticleFig(id=1241680456010232596, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522850213974730, language=CN, label=表3, caption=

2018—2020年泸州市各县(区)HIV检测成本投入(万元)

, figureFileSmall=null, figureFileBig=null, tableContent=
地区投入成本贴现成本a
2018年2019年2020年合计年均成本2018年2019年2020年合计年均成本
市本级b1 169.21 442.41 457.84 069.41 356.51 169.21 400.41 374.13 943.71 314.6
江阳区237.9344.9369.6952.4317.5237.9334.8348.4921.1307.0
纳溪区430.2520.7584.41 535.4511.8430.2505.5550.91 486.6495.5
龙马潭区335.2439.0427.81 202.0400.7335.2426.2403.31 164.7388.2
泸县644.0820.9778.82 243.7747.9644.0797.0734.12 175.1725.0
合江县393.4486.9529.11 409.4469.8393.4472.8498.71 364.9455.0
叙永县641.6720.8745.22 107.7702.6641.6699.8702.52 043.9681.3
古蔺县630.7682.6829.72 143.0714.3630.7662.8782.12 075.5691.8
合计4 482.35 458.25 722.615 663.05 221.04 482.35 299.25 394.115 175.55 058.5
), ArticleFig(id=1241680456140256027, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522850213974730, language=EN, label=Table 4, caption=

The value and source of parameters in Bernoulli-process model

, figureFileSmall=null, figureFileBig=null, tableContent=
参数符号MSM暗娼嫖客HIV阳性者配偶/固定性伴剩余男性剩余女性来源
N19 629
(15 672~23 585)
6 723
(4 482~8 964)
10 085
(67 230~134 460)
1 128
(471~1 785)
1 672 487(1 652 284~1 692 690)1 677 748(1 657 481~1 698 014)高危人群估计
Pa0.891
(0.769~0.898)
0.555
(0.350~0.759)
0.318
(0.127~0.493)
0.934 2a(0.933 3~0.940 9)0.406 2b(0.342 0~0.472 2)0.406 2b
(0.342 0~0.472 2)
哨点监测,文献[11]
p0.077 5(0.070 2~0.097 5)0.022 7(0.022 5~0.037 5)0.004 4(0.003 7~0.005 9)0.321(0.316~0.350)0.002 6(0.002 0~0.003 0)0.001 4
(0.000 8~0.002 0)
哨点监测
a0.008
(0.006~0.020)
0.003
(0.001~0.005)
0.004
(0.001~0.005)
0.2
(0.071~0.258)
0.002
(0.001~0.003)
0.003
(0.001~0.004)
文献[12-14]
e0.95
(0.800~0.990)
0.750
(0.630~0.990)
0.750
(0.630~0.830)
0.9
(0.9~0.95)
0.87
(0.6~0.99)
0.87
(0.6~0.99)
文献[14-15]
f
1
0.739
(0.606~0.801)
0.805
(0.733~0.865)
0.551
(0.438~0.665)
0.413
(0.115~0.612)
0.1
(0.09~0.13)
0.1
(0.09~0.13)
哨点监测、文献[15]
f20.878
(0.780~0.879)
0.942
(0.921~0.963)
0.740
(0.639~0.853)
0.738
(0.628~0.849)
0.3
(0.24~0.35)
0.3
(0.24~0.35)
哨点监测
n14(1.2~30)72(47.3~141.8)29.2(47.3~141.8)36(12~50)60(47.3~141.8)60(47.3~141.8)文献[14-16]
m5(1~20)20(10~50)12(10~40)2(1~5)2(1~5)2(1~5)文献[14-16]
z0(0~0.5)0(0~0.5)0(0~0.5)0(0~0.5)0(0~0.5)0(0~0.5)文献[16]
), ArticleFig(id=1241680456270279458, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522850213974730, language=CN, label=表4, caption=

Bernoulli-process模型参数取值及来源

, figureFileSmall=null, figureFileBig=null, tableContent=
参数符号MSM暗娼嫖客HIV阳性者配偶/固定性伴剩余男性剩余女性来源
N19 629
(15 672~23 585)
6 723
(4 482~8 964)
10 085
(67 230~134 460)
1 128
(471~1 785)
1 672 487(1 652 284~1 692 690)1 677 748(1 657 481~1 698 014)高危人群估计
Pa0.891
(0.769~0.898)
0.555
(0.350~0.759)
0.318
(0.127~0.493)
0.934 2a(0.933 3~0.940 9)0.406 2b(0.342 0~0.472 2)0.406 2b
(0.342 0~0.472 2)
哨点监测,文献[11]
p0.077 5(0.070 2~0.097 5)0.022 7(0.022 5~0.037 5)0.004 4(0.003 7~0.005 9)0.321(0.316~0.350)0.002 6(0.002 0~0.003 0)0.001 4
(0.000 8~0.002 0)
哨点监测
a0.008
(0.006~0.020)
0.003
(0.001~0.005)
0.004
(0.001~0.005)
0.2
(0.071~0.258)
0.002
(0.001~0.003)
0.003
(0.001~0.004)
文献[12-14]
e0.95
(0.800~0.990)
0.750
(0.630~0.990)
0.750
(0.630~0.830)
0.9
(0.9~0.95)
0.87
(0.6~0.99)
0.87
(0.6~0.99)
文献[14-15]
f
1
0.739
(0.606~0.801)
0.805
(0.733~0.865)
0.551
(0.438~0.665)
0.413
(0.115~0.612)
0.1
(0.09~0.13)
0.1
(0.09~0.13)
哨点监测、文献[15]
f20.878
(0.780~0.879)
0.942
(0.921~0.963)
0.740
(0.639~0.853)
0.738
(0.628~0.849)
0.3
(0.24~0.35)
0.3
(0.24~0.35)
哨点监测
n14(1.2~30)72(47.3~141.8)29.2(47.3~141.8)36(12~50)60(47.3~141.8)60(47.3~141.8)文献[14-16]
m5(1~20)20(10~50)12(10~40)2(1~5)2(1~5)2(1~5)文献[14-16]
z0(0~0.5)0(0~0.5)0(0~0.5)0(0~0.5)0(0~0.5)0(0~0.5)文献[16]
), ArticleFig(id=1241680456375137066, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522850213974730, language=EN, label=Table 5, caption=

Results and cost-effectiveness of HIV testing in Luzhou city from 2018 to 2020

, figureFileSmall=null, figureFileBig=null, tableContent=
实验室所属地区检测人次数(万人次)检测平均成本(元/人次)新报告病例数检出1例HIV感染者的成本
(万元/例)
2018年2019年2020年合计2018年2019年2020年合计2018年2019年2020年合计2018年2019年2020年合计
市本级12.115.613.741.496.589.9100.495.31871601324796.38.810.48.2
江阳区20.030.231.381.511.911.111.111.33474493921 1880.70.70.90.8
纳溪区12.616.016.645.234.231.533.332.92363571727651.81.43.21.9
龙马潭区14.721.619.756.022.919.720.520.82222502226941.51.71.81.7
泸县26.636.531.694.824.221.823.222.93574972921 1461.81.62.51.9
合江县20.532.334.186.819.214.614.615.75666245011 6910.70.81.00.8
叙永县18.525.225.168.834.627.828.029.72193322598102.92.12.72.5
古蔺县25.627.432.485.524.624.224.124.31812001645453.53.34.83.8
泸州市150.6204.8204.4559.929.825.926.427.12 3152 8692 1347 3181.91.82.52.1
), ArticleFig(id=1241680457889280816, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522850213974730, language=CN, label=表5, caption=

2018—2020年泸州市HIV检测结果及成本效果

, figureFileSmall=null, figureFileBig=null, tableContent=
实验室所属地区检测人次数(万人次)检测平均成本(元/人次)新报告病例数检出1例HIV感染者的成本
(万元/例)
2018年2019年2020年合计2018年2019年2020年合计2018年2019年2020年合计2018年2019年2020年合计
市本级12.115.613.741.496.589.9100.495.31871601324796.38.810.48.2
江阳区20.030.231.381.511.911.111.111.33474493921 1880.70.70.90.8
纳溪区12.616.016.645.234.231.533.332.92363571727651.81.43.21.9
龙马潭区14.721.619.756.022.919.720.520.82222502226941.51.71.81.7
泸县26.636.531.694.824.221.823.222.93574972921 1461.81.62.51.9
合江县20.532.334.186.819.214.614.615.75666245011 6910.70.81.00.8
叙永县18.525.225.168.834.627.828.029.72193322598102.92.12.72.5
古蔺县25.627.432.485.524.624.224.124.31812001645453.53.34.83.8
泸州市150.6204.8204.4559.929.825.926.427.12 3152 8692 1347 3181.91.82.52.1
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2018—2020年泸州市HIV扩大检测策略成本效果分析
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卓玛拉措 1 , 曾亚莉 1 , 冯才碧 2 , 肖体呈 2 , 刘伦皓 1 , 叶黎 1 , 袁风顺 1 , 苏玲 1 , 王秋实 1 , 徐梦娇 1 , 梁姝 1
现代预防医学 | 卫生政策与管理 2024,51(3): 484-488
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现代预防医学 | 卫生政策与管理 2024, 51(3): 484-488
2018—2020年泸州市HIV扩大检测策略成本效果分析
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卓玛拉措1, 曾亚莉1, 冯才碧2, 肖体呈2, 刘伦皓1, 叶黎1, 袁风顺1, 苏玲1, 王秋实1, 徐梦娇1, 梁姝1
作者信息
  • 1.四川省疾病预防控制中心,性病艾滋病预防控制所,四川 成都 610041
  • 2.泸州市疾病预防控制中心
  • 卓玛拉措(1991—),女,硕士,主管医师,研究方向:艾滋病防控

通讯作者:

梁姝,E-mail:
Cost-effectiveness analysis of expanded HIV testing strategy in Luzhou city from 2018 to 2020
La-cuo ZHUOMA1, Ya-li ZENG1, Cai-bi FENG2, Ti-cheng XIAO2, Lun-hao LIU1, Li YE1, Feng-shun YUAN1, Ling SU1, Qiu-shi WANG1, Meng-jiao XU1, Shu LIANG1
Affiliations
  • Institute of STD/AIDS Prevention and Control, Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan 610041,China
出版时间: 2024-02-10 doi: 10.20043/j.cnki.MPM.202308343
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目的

分析2018—2020年泸州市HIV扩大检测策略的成本效果,为当地因地制宜实施或调整该策略提供依据。

方法

通过自制的成本收集工具收集各级HIV检测机构开展检测工作的成本信息,从中国疾病预防控制信息系统获取检测人次数和新报告病例数,利用Bernoulli-process模型估计性传播途径所避免的新发感染人数,以成本效果比为指标进行成本效果分析。

结果

2018—2020年泸州市在HIV扩大检测工作中累积投入成本贴现后为15 175.5万元,三年间平均成本为5 058.5万元。三年共有559.9万人次接受HIV检测,新发现病例7 318例,检测平均成本为27.1元/人次。经Bernoulli-process模型计算得到泸州市因性传播所避免的新发感染人数为545(67~7 373)人。成本效果分析显示,2018—2020年,检出1例HIV感染者的成本为2.1万元,避免1例HIV感染者的成本为9.2(0.7~75.5)万元。

结论

泸州市2018—2020年实施的HIV扩大检测策略符合成本效果原则,具有较好的经济性。各地开展检测的成本-效果差异较大,应根据各地疫情流行现状分类实施扩大检测策略。

HIV  /  检测策略  /  成本效果分析
Objective

To analyze the cost-effectiveness of the expanded HIV testing strategy in Luzhou from 2018 to 2020, and to provide a basis for implementing or adjusting the strategy according to local conditions.

Methods

The cost data of HIV testing institutions at all levels were collected by self-made cost collection tools, and the number of tested people and newly reported cases were obtained from China Disease Prevention and Control Information system. The number of potential HIV infections averted by the sexual transmission route was estimated using the Bernoulli-process model, and the cost-effectiveness ratio was analyzed.

Results

From 2018 to 2020, the cumulative investment cost of Luzhou city in the HIV expansion testing was 151.76 million yuan after discounting, and the average cost in the three years was 50.58 million yuan. A total of 5.60 million people received HIV test in the past three years, with 7 318 new cases detected, and the average cost was 27.1 yuan per test. According to the Bernoulli-process model, the number of new infections prevented by sexual transmission in Luzhou city was 545 (67-7 373). Cost effectiveness analysis showed that from 2018 to 2020, the cost for identifying each new HIV-infected person was 21 000 yuan, and 92 000 yuan (7 000- 755 000) for preventing each HIV infection.

Conclusion

The expanded HIV testing strategy implemented in Luzhou from 2018 to 2020 accords with the cost-effectiveness principle and has economic effects. The cost-effectiveness of testing varies greatly in different regions, so the expanded testing strategy should be implemented according to the epidemic situation of different regions.

HIV  /  Detection strategy  /  Cost-effectiveness analysis
卓玛拉措, 曾亚莉, 冯才碧, 肖体呈, 刘伦皓, 叶黎, 袁风顺, 苏玲, 王秋实, 徐梦娇, 梁姝. 2018—2020年泸州市HIV扩大检测策略成本效果分析. 现代预防医学, 2024 , 51 (3) : 484 -488 . DOI: 10.20043/j.cnki.MPM.202308343
La-cuo ZHUOMA, Ya-li ZENG, Cai-bi FENG, Ti-cheng XIAO, Lun-hao LIU, Li YE, Feng-shun YUAN, Ling SU, Qiu-shi WANG, Meng-jiao XU, Shu LIANG. Cost-effectiveness analysis of expanded HIV testing strategy in Luzhou city from 2018 to 2020[J]. Modern Preventive Medicine, 2024 , 51 (3) : 484 -488 . DOI: 10.20043/j.cnki.MPM.202308343
HIV(human immunodeficiency virus,人免疫缺陷病毒)检测是发现HIV感染者、有效遏制HIV传播,实现终结艾滋病流行的重要前提[1]。四川省自2017年启动艾防攻坚以来,持续推行扩大检测策略[2],每年检测人次数大幅增加,同时成本投入也持续增加,但是检测资源的持续投入和产出是否符合成本效益原则,扩大检测策略持续推广性如何还有待研究。国外针对HIV检测策略已开展了较多的卫生经济学研究,近年来国内相关报道也陆续增多,主要集中在艾滋病自愿咨询检测、男男性行为者(men who have sex with men, MSM)筛查、示范区筛查等单一策略、特定人群或项目的评价上,而针对多渠道、大规模开展的扩大检测策略的评价较少[3-7]。本研究选择四川省泸州市作为研究试点,开展HIV扩大检测策略的成本效果分析,以评价泸州市HIV扩大检测策略的卫生经济学效益。
通过文献查阅和实地考察,了解HIV检测策略中各级政府投入情况,自制HIV检测的成本收集工具,收集泸州市各HIV检测机构开展检测的成本资料。HIV检测机构主要包括辖区具备HIV检测资质的疾病预防控制中心、血站、妇幼保健院、医院、社区卫生服务中心/乡镇卫生院。成本资料主要包括人力成本、HIV检测试剂费用、实验室一次性用品和耗材费用、实验室房屋成本、实验室固定资产费用、相关培训和督导费用等各项直接花费,参考其他相关研究对成本按照3%的贴现率进行贴现处理[8]。从中国疾病预防控制信息系统(简称“信息系统”)获取HIV检测人次数,计算检测平均成本。
效果指标主要包括新报告病例数和避免的新发感染人数。新报告病例数从信息系统获取,为按照报告地统计的数据,反应当地有效发现病例的能力;避免的新发感染人数指通过扩大检测策略实施而发现的HIV感染者,对其进行相关干预、治疗继而避免的新发感染人数。综合泸州市艾滋病疫情和专家德尔菲咨询调查确定模型构建、检验、模拟和参数选定、取值、结果分析等。泸州市近年来的传播途径主要为性传播,2010—2020年所有报告病例中,异性传播占92.3%,同性传播占6.6%[9],故本研究主要关注性传播途径所避免的新发感染人数,包括同性和异性。在异性性行为人群中,卖淫妇女、嫖客、阳性者配偶/固定性伴等不同亚人群的性行为特征及传播风险存在差异,本研究探索采用不同亚人群分别构建模型,以各亚人群估计结果的合计人数作为“异性传播所避免的新发感染人数”。
本研究采用成本-效果比(cost-effectiveness ratio,CER)进行成本效果评价,即每单位效果所需要的费用。具体指标包括检出1例HIV感染者的成本,以及避免1例HIV感染者的成本[10]。具体计算公式为:检出1例HIV感染者的成本=扩大检测成本总投入/新报告病例数;避免1例HIV感染者的成本=扩大检测成本总投入/所避免的经性传播造成的HIV新发感染人数。
利用SPSS 23.0进行数据整理及统计分析,构建Bernoulli-process模型估计泸州市因实施HIV扩大检测策略,所避免的经性传播造成的HIV新发感染人数。Bernoulli-process模型的主要原理:假定一定数量的人群,并假定在该人群中目标人群(同性或异性性行为人群)参与率(即目标人群接受HIV检测服务的比例)以及该人群中HIV的感染率,再根据性伴数量、与每一性伴性接触次数、每次性行为传播概率、安全套使用率与有效率等指标,计算该人群在无任何干预的情况下能够感染的HIV人数,以及计算对该人群进行干预后(本研究即为扩大HIV检测策略发现的感染者进行抗病毒治疗等干预)感染HIV的人数,两者之差就是避免的新发感染人数。用该模型计算出的新发感染人数为A=Ap+As,其中,Ap为避免的一代新发感染人数,As是由于避免的第一部分的新发感染人数而避免的二代感染人数,公式中的字母含义见表1。公式如下:
2018—2020年泸州市在HIV扩大检测工作中累积投入成本15 663.0万元,三年间平均成本为5 221.0万元。从各项花费看,检测人力(年均1 793.3万元)和检测试剂(年均1 708.2万元)成本投入最大。各级机构调查结果显示,泸州市市本级机构HIV检测成本投入最高,三年年均成本达到1 356.5万元,各县(区)结果显示,泸县(年均747.9万元)、古蔺县(年均714.3万元)和叙永县(702.6万元)检测成本投入最高。用3%的贴现率贴现到2018年后,三年累积投入成本15 175.5万元,三年平均成本5 058.5万元。见表23
根据表4各参数取值及其变化范围,代入Bernoulli-process模型计算得到MSM人群经性传播所避免的新发感染人数为180(2~2 093)人;异性性行为人群经性传播所避免的新发感染人数为365(65~5 280)人,亚人群计算结果分别为暗娼67(4~1 097)人、嫖客5(4~1 921)人、HIV阳性者配偶/固定性伴57(44~98)人、剩余男性133(9~1 201)人、剩余女性103(4~963)人。由此计算得出,2018—2020年泸州市每年因扩大检测工作经性传播所避免的新发感染人数为545(67~7 373)人。
2018—2020年,共有559.9万人次接受HIV检测,新发现病例7 318例。三年检测平均成本为27.1元/人次,其中2018年最高,为29.8元/人次,2019年最低,为25.9元/人次。成本-效果分析发现,检出1例 HIV感染者的成本为2.1万元,其中2020年最高,为2.5万元/例,2019年最低,为1.8万元/例。与各县(区)比较,市本级检出1例 HIV感染者的成本最高,三年检出1例 HIV感染者的成本8.2万元。各县(区)比较发现,检出1例 HIV感染者的成本古蔺县最高,为3.8万元/例,江阳区和合江县最低,为0.8万元/例。见表5
根据3年来平均成本投入和估计的避免新发感染人数,每避免1例HIV感染者需要9.2(0.7~75.5)万元。
泸州市自全面实施HIV扩大检测策略以来,检测力度持续增加,检测人次数从2018年的150余万增加到2020年的200多万,如此大规模的检测力度离不开资源的投入。本研究从政府在艾滋病检测领域投入的角度出发分析了泸州市HIV扩大检测策略的成本效果。本研究在选取效果指标时,除利用HIV检测数据外,还利用Bernoulli-process模型计算了性传播途径所避免的新发感染人数。以往研究在构建模型时,直接分同性和异性性行为人群进行计算[16],这种处理方法忽视了异性性行为人群中不同亚人群的感染风险差异,所以本研究在异性性行为的群体中划分不同亚人群,并基于泸州市疫情估计、哨点监测、病例报告等数据进行估计,保证估计结果更能贴近泸州市实际情况。本研究泸州市因性传播所避免的新发感染人数估计结果为545人,波动范围为67~7 373人,估计结果波动范围较大,一方面是因为高危人群规模估计数据本身的波动范围较大,另一方是因为模型中参数较多,优先使用现实数据的前提下,仍有多个参数来源于国内外文献资料,导致最终模型结果波动范围较大。
本研究发现,泸州市每人次检测成本为27.1元/人次,远低于南昌市VCT次均检测成本[7],说明相对于单一策略,扩大检测策略可有效降低单位检测成本。泸州市检出1例HIV感染者的成本为2.1万元/例,与国内各地研究结果均有差异[16-17]。相关研究认为,当实施项目后获得的成本效果比小于3倍的人均GDP(国内生产总值)即可认为该项目具有成本效果,小于1倍的人均GDP则认为具有极佳的成本效果,而大于3倍的人均GDP则不具备经济性[18]。根据此原则,参考《泸州统计年鉴》[19],泸州市2018—2020年的人均GDP均在4万元以上,故本研究泸州市检出1例的成本小于同期1倍的人均GDP,具有极佳的成本效果。从不同县(区)看,江阳区和合江县最低,而古蔺县最高,这与各县(区)疫情严重程度有关,江阳区和合江县疫情较重,而古蔺县疫情最轻,与其他研究结果相似,即HIV确证阳性率越高的地区,新发现1个病例的成本越低[20]
与各县(区)比较发现,泸州市本级投入成本最高,成本-效果比最高,主要是因为,一方面市本级单位因检测实验室要求高,且实验室地理位置位于市中心导致房屋、固定资产成本高;另一方面,市本级单位中血站来源检测量大,且血站单位试剂成本相对更高。
总体来看,本研究发现泸州市2018—2020年实施的HIV扩大检测策略具有较好的经济性,但研究仍存在一定的不足之处,首先,检测成本计算过程中可能对工作人员工作量、固定资产费用、房屋成本等存在错估;其次,在构建模型时,部分参数来源于艾滋病疫情估计及国内外文献结果,可能与泸州市实际情况存在一定差异,模拟结果对实际情况的代表性有待进一步探讨;最后,本研究未收集到扩大检测策略实施之前的成本资料,无法对比HIV扩大检测实施前后的成本-效果情况。
  • 四川省疾病预防控制中心自立课题(ZX202014)
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doi: 10.20043/j.cnki.MPM.202308343
  • 接收时间:2023-08-18
  • 首发时间:2026-03-19
  • 出版时间:2024-02-10
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  • 收稿日期:2023-08-18
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四川省疾病预防控制中心自立课题(ZX202014)
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    1.四川省疾病预防控制中心,性病艾滋病预防控制所,四川 成都 610041
    2.泸州市疾病预防控制中心

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2种不同金属材料的力学参数

Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)

Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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