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中国防痨杂志 ›› 2023, Vol. 45 ›› Issue (9): 845-856.doi: 10.19982/j.issn.1000-6621.20230143

• 论著 • 上一篇    下一篇

全国结核病免费医疗策略实施的效果和影响预测

周文雍1,2, 文泽轩1,2, 高梦贤1,2, 李涛3, 张慧3(), 王伟炳1,2()   

  1. 1复旦大学上海市重大传染病和生物安全研究院,上海 200032
    2复旦大学公共卫生学院流行病学教研室/公共卫生安全教育部重点实验室,上海 200032
    3中国疾病预防控制中心结核病预防控制中心,北京 102206
  • 收稿日期:2023-05-06 出版日期:2023-09-10 发布日期:2023-09-01
  • 通信作者: 王伟炳,Email:wwb@fudan.edu.cn;张慧,Email:zhanghui@chinacdc.cn
  • 基金资助:
    加强重大传染病防控政策倡导项目(INV-035022)

Prediction of the effectiveness and impact of the free healthcare policy for tuberculosis in China

Zhou Wenyong1,2, Wen Zexuan1,2, Gao Mengxian1,2, Li Tao3, Zhang Hui3(), Wang Weibing1,2()   

  1. 1Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200032, China
    2Department of Epidemiology, Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China
    3National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
  • Received:2023-05-06 Online:2023-09-10 Published:2023-09-01
  • Contact: Wang Weibing, Email: wwb@fudan.edu.cn; Zhang Hui, Email: zhanghui@chinacdc.cn
  • Supported by:
    Policy Advocacy for Strengthening the Prevention and Control of Major Infectious Diseases(INV-035022)

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摘要：

目的: 对我国的结核病免费医疗政策实施对结核病疫情和经济的近远期影响进行预测,为在我国实行结核病免费医疗的必要性和可行性提供科学依据。方法: 基于结核病自然史等搭建结核病传播动力学模型,并分别在假设年发病例数递降率维持不变及假设在其他干预措施的影响下,年发病例数递降率逐渐增大的两个模拟场景下,预测结核病免费医疗方案实施对我国结核病疫情变化趋势的影响,并采用成本-效果、成本-效用和成本-效益等常用卫生经济学方法评估结核病免费医疗政策的经费投入所产生的社会效益。结果: 递降率维持现有水平时,到2035年可累计减少7584954例结核分枝杆菌潜伏感染(latent tuberculosis infection,LTBI)者和390333例结核病发病患者,可累计增加195486例成功治疗的敏感结核病患者和62251例耐药结核病患者,能够挽回2448501伤残调整生命年(disability adjusted life year,DALY)和27328042万元的社会经济价值,政府每额外投入1元可挽回社会经济价值11.24元;年发病率递降速率增大时,到2035年可累计减少5730438例LTBI和273441例结核病发病患者,可累计增加179592例成功治疗的敏感结核病患者和49835例耐药结核病患者,能够挽回2179554 DALY和23310346万元的社会经济价值,政府每额外投入1元可挽回社会经济价值12.58元。结论: 免费医疗方案的实施能明显减少结核病的传播,对于挽回社会经济价值的效果十分显著,而这些效果在年发病例数递降率增大的情景下更佳,建议政府尽早实施结核病免费医疗方案,并实施其他干预措施控制结核病的传播。

关键词: 结核, 传染病控制, 免费医疗, 模型, 统计学, 预测

Abstract:

Objective: This study predicted the short-term and long-term epidemiological and economic impacts of the implementation of free tuberculosis (TB) healthcare policy in China, providing scientific evidence for the necessity and feasibility of free TB healthcare policy in China. Methods: Based on the natural history of TB, a TB dynamic model was developed, and two simulation scenarios were simulated to predict the impact of implementing free TB healthcare policy on the trend of TB epidemic, assuming a constant decline rate of annual incidence of TB and a gradually increasing decline rate of annual incidence of TB under other interventions, respectively. The cost-effectiveness, cost-utility, and cost-benefit analyses were conducted to evaluate the social benefits of the government’s investment on free TB healthcare policy. Results: With the free TB health care policy, when the decline rate is maintained at the current level, by 2035, 7584954 latent TB infections (LTBI) and 390333 TB cases can be avoided cumulatively, 195486 successfully treated drug-sensitive TB patients and 62251 drug-resistant TB patients can be increased cumulatively, and 2448501 disability-adjusted life years (DALY) and a social economic value of 273280420000 yuan can be saved. Every extra yuan invested by the government can generate a social economic value of 11.24 yuan. When the decline rate increases, by 2035, 5730438 LTBI and 273441 TB cases can be avoided cumulatively, 179592 successfully treated drug-sensitive TB patients and 49835 drug-resistant TB patients can be increased cumulatively, and 2179554 DALY and a social economic value of 233103460000 yuan can be saved. Every extra yuan invested by the government can generate a social economic value of 12.58 yuan. Conclusion: Implementing free TB healthcare policy can significantly reduce the transmission of TB and has a significant effect on saving social economic cost. These effects are more significant when the annual incidence of TB declines faster. It is recommended that the government shall implement free TB healthcare policy as soon as possible and other interventions to control the spread of TB.

Key words: Tuberculosis, Communicable disease control, Uncompensated care, Models, statistical, Forecasting

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