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Objective@#To edentify the increased cost, the decreased benefits and effectiveness of hepatitis B vaccine event reported by media in 2013 in China both in Chinese nationwide and in Shenzhen.@*Methods@#The decision analytic-Markov models were constructed. The cohort born in 2013 in nationwide and in Shenzhen were respectively introduced to the models. The vaccination coverage and the rates of antibody to hepatitis B surface antigen were determined as major parameters. The average costs and benefits per case, the effectiveness which included the numbers of hepatitis B virus (HBV) infection and the patients with HBV-related diseases, the average quality-adjusted life years (QALYs) per case were calculated from the medical-care and societal perspectives. The benefit cost ratio (BCR), ratio of the total costs and the net QALYs were as indicators of cost-benefit and cost-effectiveness analysis, respictively.@*Results@#In nationwide, the BCRs decreased from 9.10 and 8.58 to 2.48 and 2.43, respectively, because the average costs increased to 6 796.60 yuan (RMB) and 8 451.45 yuan, and average benefits decreased to 6 799.57 yuan and 8 484.41 yuan, respectively, from the medical-care and societal perspectives. In Shenzhen, the BCRs decreased from 16.21 and 14.51 to 3.11 and 3.04 with the average costs of 5 244.88 yuan and 8 937.64 yuan, and average benefits of 5 248.11 yuan and 8 977.27 yuan. Totally, the increase of 2.1314 million and 181 hundreds of the HBV infectors occurred for the event in nationwide and in Shenzhen, respectively. Of all the infectors increased the most, the numbers of acute and chronic hepatitis B were 1 904 hundreds and 807 hundreds in nationwide, 794 and 395 in Shenzhen, espectively. The decreases of average QALY per case were 0.119 8 in nationwide and 0.090 6 in Shenzhen. The costs per averted a QALY increased from 6 231.90 yuan to 22 883.51 yuan in nationwide, from 3 567.25 yuan to 1 8571.49 yuan in Shenzhen (for medical-care perspective), from 8 252.79 yuan and 6 807.45 yuan to 29 091.92 yuan and 32 553.60 yuan (for societal perspective).@*Conclusion@#The hepatitis B vaccine event reported by media in 2013 in China caused the costs increased, both benefits and the economic values obviously decreased.
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Objective@#To verify the costs, benefit and effectiveness of hepatitis B immunoprophylaxis strategies in Shenzhen during 2006-2030.@*Methods@#The markov model was constructed to reflect the reality of the newborn vaccination and prevention of mother to child transmission (PMTCT) strategy, the cost, benefit and effectiveness during 2006-2015 and 2016-2030 was evaluated and predicted by the model. The model was constructed with the basic parameters such as the positive rate of hepatitis B surface antibody, perinatal HBV infection rate, the screening rate and positive rate of HBsAg of pregnant women, the utility value of hepatitis B and the parameters of markov model. and the coverage rates, vaccination fee of hepatitis B and the expenditures of patients with HB-related diseases.The costs were calculated from the payer, medical-care and all society perspective. The effectiveness and benefits of the strategy were evaluated and predicted by the numbers of HBV infection and the patients with HBV-related diseases prevented, life years (LYs), quality adjusted life years (QALYs), the net benefits (NBs) and benefit cost ratio (BCRs).@*Results@#From the payer, medical-care and all society perspectives, the costs for the strategy were 153 million Yuan, 5.51 billion Yuan and 10.92 billion Yuan, respectively from 2006 to 2030 of which the forecast costs for 2016-2030 were 120 million Yuan, 3.87 billion yuan and 7.81 billion yuan. During the year 2006-2030, the numbers of HBV infection and the HBV-related diseases was 2.48 million, more than 1.335 million LYs and 1.619 million QALYs should be obtained from the strategy implemented. From medical-care and all society perspectives, NBs should be 88.68 billion yuan and 150.13 billion yuan with the BCRs of 17.08 and 14.75, respectively. Particularly, the NBs value of 22.37 billion yuan and 37.98 billion yuan and the BCR value of 14.62 and 13.20 was calculated for the past period, but the future NBs of 66.31 billion yuan and 112.15 billion yuan and BCR of 18.12 and 15.36 in the year 2016-2030. The further benefits were increased evidently in the future.@*Conclusion@#The hepatitis B immunization in Shenzhen has a high economic effectivenee and benefits, and it is worth to invest sustainably.
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Objective Less surveys on the economic burden of hepatitis B (HB)-related diseases have been conducted in China,so the socioeconomic harm caused by the diseases is not clear and the key parameters for economic evaluation of hepatitis B prevention and treatment are lacking.This study aimed to analyze the direct,indirect and intangible expenditures of hospitalized patients with HB-related diseases during hospitalization and during a year in different areas of China.Methods The hospitals for infectious diseases and the large general hospitals in 12 areas in China were selected in the study.All the inpatients with HB-related diseases were surveyed by cluster sampling of consecutive cases.The direct expenditure included direct medical cost and direct non-medical cost.The indirect expenditure,including work loss of patients and caregivers,were calculated by using human capital method for urban and rural populations in 12 areas.The intangible expenditure were reflected by willing to pay and stochastic tournament.The influencing factors of direct and indirect costs were identified by stepwise linear multi-variation regression analysis.Results A total of 27 hospitals in 12 areas were included in the survey.A total of 4 718 cases were surveyed,the overall response rate was 77.7％.The average hospital stay was 29.2 days (27-34) and the hospitalization expenditure was averagely 16 832.80 yuan (RMB) per case,in which the highest proportion (61.2％)was medicine fees [10 365.10 yuan (RMB)].The average direct expenditure and indirect expenditure were consistent with the severity of illness,which were 18 336.10 yuan (RMB) and 4 759.60 yuan (RMB) respectively,with the ratio of 3.85:1.The direct medical expenditure [17 434.70 yuan (RMB)] were substantially higher than the direct non-medical expenditure [901.40 yuan (RMB)].It was found that the hospitalization expenses was highest in direct medical expenditure and the transportation expenses was highest in direct non-medical expenditures.Among the average indirect expenditure,the loss of income for the patients [3 832.50 yuan (RMB)] was higher than that for the caregivers [927.20 yuan (RMB)],The total direct and indirect expenditure was highest for liver transplantation,followed by severe hepatitis,hepatocellular carcinoma and decompensated cirrhosis,acute hepatitis B,compensated cirrhosis and chronic hepatitis B.The influencing factors for both direct and indirect expenditure were high hospital level,severity of hepatitis B,living in urban area,antiviral therapy,long hospitalization and monthly income of family.For average 3.74 outpatient visits and 1.51 hospitalization,the average annual direct,indirect and intangible expenditure for HB-related diseases were 30 135.30,6 253.80 and 44 729.90 yuan (RMB) [totally 81 119.00 yuan (RMB)],accounting for 37.3％,7.7％ and 55.0％,respectively.Of the annual direct medical expenditure [28 402.80 yuan (RMB)],which were much higher than non-medical expenditure [1 732.50 yuan (RMB)],hospitalization expenditure [26 074.20 yuan (RMB)] was higher than outpatient visit expenditure [4 061.10 yuan (RMB)].The annual indirect expenditures for outpatient visit and hospitalization were 763.60 and 5 490.10 yuan (RMB),respectively.Of the annual intangible expenditure,the highest was that for/primary hepatocellular carcinoma,followed by cirrhosis,chronic hepatitis B,severe hepatitis B,liver transplantation and acute hepatitis B.Conclusions A heavy economic burden has been caused by HB-related diseases in China,and patients are more likely to rely on medical service rather than non-medical service.It is necessary to take effective treatment measures to prevent the adverse outcome of HB related diseases and achieve significant economic benefits.The influence of HB related diseases on mental health of the people can be reflected by an economics term,intangible expenditure.
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Objective Since eliminating hepatitis B in China would need considerable public health resources,the economics problem of the strategy of community-based antiviral treatment for chronic hepatitis B (CHB) has become an important issue.The cost-effectiveness and affordability of the strategy were evaluated in this study.Methods According to the advocacy on eliminating hepatitis B by WHO and the comprehensive protocol of community based prevention of major infectious diseases and the guideline for CHB prevention and treatment in China,the decision analytic Markov model was constructed with the parameters from national surveys or Meta-analysis.A cohort population aged 20-59 years was used as study subjects.The strategy of CHB antiviral treatment was compared with the strategies of hepatitis B vaccination and non-intervention,respectively.The costs and disability-adjusted life years (QALYs) of the strategies were calculated from the societal and payer perspectives.The incremental cost-effectiveness ratio (ICER) and the cost-effectiveness ratio (CER)were calculated for the comparison of the strategies.One-way and probability sensitivity analysis were performed for uncertainty of the results.And the cost-effectiveness and affordability curves were introduced to estimate the budget impact on the strategies.Results In the Chinese aged 20-59 years,the ICER of CHB antiviral treatment was 37598.6 yuan (RMB) per QALYs and the ICERs were smaller in the low age groups,indicating that the antiviral treatment strategy is cost-effective and low age groups should be the priority population.The ICER of hepatitis B vaccination was-64 000.0 yuan (RMB) per QALYs,indicating that hepatitis B vaccination is cost saving.The CER of CHB antiviral treatment ranged from 731.8 to 1813.3 yuan (RMB) pcr QALYs compared with hepatitis B vaccination,and the CER of CHB antiviral treatment was higher than that of hepatitis B vaccination in all age groups,indicating that hepatitis B vaccination would be more cost-effective than CHB antiviral treatment.The price of antiviral drug,entercavir,can influence the cost effectiveness of CHB antiviral treatment.If the price of entercavir declined half,CHB antiviral treatment would be cost-saving.The probability sensitivity analysis showed that people's willing to pay for CHB antiviral treatment should not be ignored,although the results of economics evaluation of CHB antiviral treatment were reliable.The results of affordability analysis indicated that the antiviral treatment strategy could not be implemented with the budget lower than 30 million yuan (RMB),the probability of implementing the strategy was 42.6％ if the budget reaches 127 million yuan (RMB),and only when the budget reaches 269 million yuan (RMB),the goal of CHB antiviral treatment strategy can be fully realized.Conclusions Although the strategy of CHB antiviral treatment as prevention in Chinese aged 20-59 years is cost-effective,it is not an appropriate public health measure due to the high cost.The cost effectiveness would be higher by conducting hepatitis B vaccination and then antiviral treatment in susceptible population.
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Objective To evaluate the cost effectiveness of nationwide prevention of mother to child transmission (PMTCT) strategy for hepatitis B,and estimate the willing to pay and budget impacts on the PMTCT.Methods The decision analytic Markov model for the PMTCT was constructed and a birth cohort of Chinese infants born in 2013 was used to calculate the cost-effectiveness of the PMTCT among them compared with those receiving no intervention.The parameters in the model were obtained from literatures of national surveys or Meta-analysis.The costs,cases of HBV-related diseases and quality-adjusted life-years (QALYs) were obtained from the societal and payer perspectives,respectively.The incremental cost-effectiveness ratio (ICER) was used as measures of strategy optimization.One-way and probability sensitivity analysis were performed to explore the uncertainty of the primary results.In addition,cost-effectiveness acceptability curve and cost-effectiveness affordability curves were drawn to illustrate the cost effectiveness threshold and financial budget of the PMTCT strategy.Results The lifetime cost for PMTCT strategy was 4 063.5 yuan (RMB) per carrier,which was 37 829.7 yuan (RMB) lower compared with those receiving no intervention.Due to the strategy,a total of 24.516 1 QALYs per person would be gained,which was higher than that in those receiving no intervention.From societal perspective,the ICER was-59 136.6yuan (RMB) per additional QALYs gained,indicating that the PMTCT is cost effective.The results were reliable indicated by one-way,multi-way and probability sensitivity analyses.By the CEAC,the willing to pay was much lower than the cost-effectiveness threshold.From the affordability curve of the PMTCT strategy,the annual budget ranged from 590.4 million yuan (RMB) to 688.8 million yuan (RMB),which was lower than the financial ability.Based on the results of cost-effectiveness affordability curves,the higher annual budget was determined,the higher probability of affordability for the PMTCT would be obtained under the same willing to pay state.Only when the annual budget reaches 688.8 million yuan (RMB),the goal of PMTCT would be fully realized.Conclusions The PMTCT strategy in China was cost effective,and the cost is not beyond the financial budget needed and the willing to pay.The strategy,which is consistent with the global hepatitis B elimination efforts,should be conducted widely in China.
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Objective To construct the Markov models to reflect the reality of prevention and treatment interventions against hepatitis B virus (HBV) infection,simulate the natural history of HBV infection in different age groups and provide evidence for the economics evaluations of hepatitis B vaccination and population-based antiviral treatment in China.Methods According to the theory and techniques of Markov chain,the Markov models of Chinese HBV epidemic were developed based on the national data and related literature both at home and abroad,including the settings of Markov model states,allowable transitions and initial and transition probabilities.The model construction,operation and verification were conducted by using software TreeAge Pro 2015.Results Several types of Markov models were constructed to describe the disease progression of HBV infection in neonatal period,perinatal period or adulthood,the progression of chronic hepatitis B after antiviral therapy,hepatitis B prevention and control in adults,chronic hepatitis B antiviral treatment and the natural progression of chronic hepatitis B in general population.The model for the newborn was fundamental which included ten states,i.e.susceptiblity to HBV,HBsAg clearance,immune tolerance,immune clearance,low replication,HBeAg negative CHB,compensated cirrhosis,decompensated cirrhosis,hepatocellular carcinoma (HCC) and death.The susceptible state to HBV was excluded in the perinatal period model,and the immune tolerance state was excluded in the adulthood model.The model for general population only included two states,survive and death.Among the 5 types of models,there were 9 initial states assigned with initial probabilities,and 27 states for transition probabilities.The results of model verifications showed that the probability curves were basically consistent with the situation of HBV epidemic in China.Conclusion The Markov models developed can be used in economics evaluation of hepatitis B vaccination and treatment for the elimination of HBV infection in China though the structures and parameters in the model have uncertainty with dynamic natures.
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WHO has developed and issued global hepatitis B elimination program.Continuing hepatitis B immunization and conducting community based antiviral treatment for chronic hepatitis B are the most important strategies for hepatitis B elimination.According to the estimation of related cost by WHO,the cost of antiviral therapy would be very high.Great achievement has been made in hepatitis B immunization in China,but the prevalence of chronic hepatitis B is high.Elimination of hepatitis B needs a large amount of public resource,posing serious challenge to public health policy making.Economics research on hepatitis B prevention and treatment can provide evidence and technical support for hepatitis B elimination.In this column “Economic evaluations of hepatitis B”,the related articles in this issue summarize the progress in this research field,which is inspiring and encouraging.
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Objective Less surveys on the economic burden of hepatitis B (HB)-related diseases have been conducted in China,so the socioeconomic harm caused by the diseases is not clear and the key parameters for economic evaluation of hepatitis B prevention and treatment are lacking.This study aimed to analyze the direct,indirect and intangible expenditures of hospitalized patients with HB-related diseases during hospitalization and during a year in different areas of China.Methods The hospitals for infectious diseases and the large general hospitals in 12 areas in China were selected in the study.All the inpatients with HB-related diseases were surveyed by cluster sampling of consecutive cases.The direct expenditure included direct medical cost and direct non-medical cost.The indirect expenditure,including work loss of patients and caregivers,were calculated by using human capital method for urban and rural populations in 12 areas.The intangible expenditure were reflected by willing to pay and stochastic tournament.The influencing factors of direct and indirect costs were identified by stepwise linear multi-variation regression analysis.Results A total of 27 hospitals in 12 areas were included in the survey.A total of 4 718 cases were surveyed,the overall response rate was 77.7％.The average hospital stay was 29.2 days (27-34) and the hospitalization expenditure was averagely 16 832.80 yuan (RMB) per case,in which the highest proportion (61.2％)was medicine fees [10 365.10 yuan (RMB)].The average direct expenditure and indirect expenditure were consistent with the severity of illness,which were 18 336.10 yuan (RMB) and 4 759.60 yuan (RMB) respectively,with the ratio of 3.85:1.The direct medical expenditure [17 434.70 yuan (RMB)] were substantially higher than the direct non-medical expenditure [901.40 yuan (RMB)].It was found that the hospitalization expenses was highest in direct medical expenditure and the transportation expenses was highest in direct non-medical expenditures.Among the average indirect expenditure,the loss of income for the patients [3 832.50 yuan (RMB)] was higher than that for the caregivers [927.20 yuan (RMB)],The total direct and indirect expenditure was highest for liver transplantation,followed by severe hepatitis,hepatocellular carcinoma and decompensated cirrhosis,acute hepatitis B,compensated cirrhosis and chronic hepatitis B.The influencing factors for both direct and indirect expenditure were high hospital level,severity of hepatitis B,living in urban area,antiviral therapy,long hospitalization and monthly income of family.For average 3.74 outpatient visits and 1.51 hospitalization,the average annual direct,indirect and intangible expenditure for HB-related diseases were 30 135.30,6 253.80 and 44 729.90 yuan (RMB) [totally 81 119.00 yuan (RMB)],accounting for 37.3％,7.7％ and 55.0％,respectively.Of the annual direct medical expenditure [28 402.80 yuan (RMB)],which were much higher than non-medical expenditure [1 732.50 yuan (RMB)],hospitalization expenditure [26 074.20 yuan (RMB)] was higher than outpatient visit expenditure [4 061.10 yuan (RMB)].The annual indirect expenditures for outpatient visit and hospitalization were 763.60 and 5 490.10 yuan (RMB),respectively.Of the annual intangible expenditure,the highest was that for/primary hepatocellular carcinoma,followed by cirrhosis,chronic hepatitis B,severe hepatitis B,liver transplantation and acute hepatitis B.Conclusions A heavy economic burden has been caused by HB-related diseases in China,and patients are more likely to rely on medical service rather than non-medical service.It is necessary to take effective treatment measures to prevent the adverse outcome of HB related diseases and achieve significant economic benefits.The influence of HB related diseases on mental health of the people can be reflected by an economics term,intangible expenditure.
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Objective Since eliminating hepatitis B in China would need considerable public health resources,the economics problem of the strategy of community-based antiviral treatment for chronic hepatitis B (CHB) has become an important issue.The cost-effectiveness and affordability of the strategy were evaluated in this study.Methods According to the advocacy on eliminating hepatitis B by WHO and the comprehensive protocol of community based prevention of major infectious diseases and the guideline for CHB prevention and treatment in China,the decision analytic Markov model was constructed with the parameters from national surveys or Meta-analysis.A cohort population aged 20-59 years was used as study subjects.The strategy of CHB antiviral treatment was compared with the strategies of hepatitis B vaccination and non-intervention,respectively.The costs and disability-adjusted life years (QALYs) of the strategies were calculated from the societal and payer perspectives.The incremental cost-effectiveness ratio (ICER) and the cost-effectiveness ratio (CER)were calculated for the comparison of the strategies.One-way and probability sensitivity analysis were performed for uncertainty of the results.And the cost-effectiveness and affordability curves were introduced to estimate the budget impact on the strategies.Results In the Chinese aged 20-59 years,the ICER of CHB antiviral treatment was 37598.6 yuan (RMB) per QALYs and the ICERs were smaller in the low age groups,indicating that the antiviral treatment strategy is cost-effective and low age groups should be the priority population.The ICER of hepatitis B vaccination was-64 000.0 yuan (RMB) per QALYs,indicating that hepatitis B vaccination is cost saving.The CER of CHB antiviral treatment ranged from 731.8 to 1813.3 yuan (RMB) pcr QALYs compared with hepatitis B vaccination,and the CER of CHB antiviral treatment was higher than that of hepatitis B vaccination in all age groups,indicating that hepatitis B vaccination would be more cost-effective than CHB antiviral treatment.The price of antiviral drug,entercavir,can influence the cost effectiveness of CHB antiviral treatment.If the price of entercavir declined half,CHB antiviral treatment would be cost-saving.The probability sensitivity analysis showed that people's willing to pay for CHB antiviral treatment should not be ignored,although the results of economics evaluation of CHB antiviral treatment were reliable.The results of affordability analysis indicated that the antiviral treatment strategy could not be implemented with the budget lower than 30 million yuan (RMB),the probability of implementing the strategy was 42.6％ if the budget reaches 127 million yuan (RMB),and only when the budget reaches 269 million yuan (RMB),the goal of CHB antiviral treatment strategy can be fully realized.Conclusions Although the strategy of CHB antiviral treatment as prevention in Chinese aged 20-59 years is cost-effective,it is not an appropriate public health measure due to the high cost.The cost effectiveness would be higher by conducting hepatitis B vaccination and then antiviral treatment in susceptible population.
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Objective To evaluate the cost effectiveness of nationwide prevention of mother to child transmission (PMTCT) strategy for hepatitis B,and estimate the willing to pay and budget impacts on the PMTCT.Methods The decision analytic Markov model for the PMTCT was constructed and a birth cohort of Chinese infants born in 2013 was used to calculate the cost-effectiveness of the PMTCT among them compared with those receiving no intervention.The parameters in the model were obtained from literatures of national surveys or Meta-analysis.The costs,cases of HBV-related diseases and quality-adjusted life-years (QALYs) were obtained from the societal and payer perspectives,respectively.The incremental cost-effectiveness ratio (ICER) was used as measures of strategy optimization.One-way and probability sensitivity analysis were performed to explore the uncertainty of the primary results.In addition,cost-effectiveness acceptability curve and cost-effectiveness affordability curves were drawn to illustrate the cost effectiveness threshold and financial budget of the PMTCT strategy.Results The lifetime cost for PMTCT strategy was 4 063.5 yuan (RMB) per carrier,which was 37 829.7 yuan (RMB) lower compared with those receiving no intervention.Due to the strategy,a total of 24.516 1 QALYs per person would be gained,which was higher than that in those receiving no intervention.From societal perspective,the ICER was-59 136.6yuan (RMB) per additional QALYs gained,indicating that the PMTCT is cost effective.The results were reliable indicated by one-way,multi-way and probability sensitivity analyses.By the CEAC,the willing to pay was much lower than the cost-effectiveness threshold.From the affordability curve of the PMTCT strategy,the annual budget ranged from 590.4 million yuan (RMB) to 688.8 million yuan (RMB),which was lower than the financial ability.Based on the results of cost-effectiveness affordability curves,the higher annual budget was determined,the higher probability of affordability for the PMTCT would be obtained under the same willing to pay state.Only when the annual budget reaches 688.8 million yuan (RMB),the goal of PMTCT would be fully realized.Conclusions The PMTCT strategy in China was cost effective,and the cost is not beyond the financial budget needed and the willing to pay.The strategy,which is consistent with the global hepatitis B elimination efforts,should be conducted widely in China.
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Objective To construct the Markov models to reflect the reality of prevention and treatment interventions against hepatitis B virus (HBV) infection,simulate the natural history of HBV infection in different age groups and provide evidence for the economics evaluations of hepatitis B vaccination and population-based antiviral treatment in China.Methods According to the theory and techniques of Markov chain,the Markov models of Chinese HBV epidemic were developed based on the national data and related literature both at home and abroad,including the settings of Markov model states,allowable transitions and initial and transition probabilities.The model construction,operation and verification were conducted by using software TreeAge Pro 2015.Results Several types of Markov models were constructed to describe the disease progression of HBV infection in neonatal period,perinatal period or adulthood,the progression of chronic hepatitis B after antiviral therapy,hepatitis B prevention and control in adults,chronic hepatitis B antiviral treatment and the natural progression of chronic hepatitis B in general population.The model for the newborn was fundamental which included ten states,i.e.susceptiblity to HBV,HBsAg clearance,immune tolerance,immune clearance,low replication,HBeAg negative CHB,compensated cirrhosis,decompensated cirrhosis,hepatocellular carcinoma (HCC) and death.The susceptible state to HBV was excluded in the perinatal period model,and the immune tolerance state was excluded in the adulthood model.The model for general population only included two states,survive and death.Among the 5 types of models,there were 9 initial states assigned with initial probabilities,and 27 states for transition probabilities.The results of model verifications showed that the probability curves were basically consistent with the situation of HBV epidemic in China.Conclusion The Markov models developed can be used in economics evaluation of hepatitis B vaccination and treatment for the elimination of HBV infection in China though the structures and parameters in the model have uncertainty with dynamic natures.
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WHO has developed and issued global hepatitis B elimination program.Continuing hepatitis B immunization and conducting community based antiviral treatment for chronic hepatitis B are the most important strategies for hepatitis B elimination.According to the estimation of related cost by WHO,the cost of antiviral therapy would be very high.Great achievement has been made in hepatitis B immunization in China,but the prevalence of chronic hepatitis B is high.Elimination of hepatitis B needs a large amount of public resource,posing serious challenge to public health policy making.Economics research on hepatitis B prevention and treatment can provide evidence and technical support for hepatitis B elimination.In this column “Economic evaluations of hepatitis B”,the related articles in this issue summarize the progress in this research field,which is inspiring and encouraging.
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Objective Through cost-benefit analysis (CBA),cost-effectiveness analysis (CEA) and quantitative optimization analysis to understand the economic benefit and outcomes of strategy regarding preventing mother-to-child transmission (PMTCT) on hepatitis B virus.Methods Based on the principle of Hepatitis B immunization decision analytic-Markov model,strategies on PMTCT and universal vaccination were compared.Related parameters of Shenzhen were introduced to the model,a birth cohort was set up as the study population in 2013.The net present value (NPV),benefit-cost ratio (BCR),incremental cost-effectiveness ratio (ICER) were calculated and the differences between CBA and CEA were compared.Results A decision tree was built as the decision analysis model for hepatitis B immunization.Three kinds of Markov models were used to simulate the outcomes after the implementation of vaccination program.The PMTCT strategy of Shenzhen showed a net-gain as 38 097.51 Yuan/per person in 2013,with BCR as 14.37.The universal vaccination strategy showed a net-gain as 37 083.03 Yuan/per person,with BCR as 12.07.Data showed that the PMTCT strategy was better than the universal vaccination one and would end with gaining more economic benefit.When comparing with the universal vaccination program,the PMTCT strategy would save 85 100.00 Yuan more on QALY gains for every person.The PMTCT strategy seemed more cost-effective compared with the one under universal vaccination program.In the CBA and CEA hepatitis B immunization programs,the immunization coverage rate and costs of hepatitis B related diseases were the most important influencing factors.Outcomes of joint-changes of all the parameters in CEA showed that PMTCT strategy was a more cost-effective.Conclusions The PMTCT strategy gained more economic benefit and effects on health.However,the cost of PMTCT strategy was more than the universal vaccination program,thus it is important to pay attention to the process of PMTCT strategy and the universal vaccination program.CBA seemed suitable for strategy optimization while CEA was better for strategy evaluation.Hopefully,programs as combination of the above said two methods would facilitate the process of economic evaluation.
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Objective Through cost-benefit analysis (CBA),cost-effectiveness analysis (CEA) and quantitative optimization analysis to understand the economic benefit and outcomes of strategy regarding preventing mother-to-child transmission (PMTCT) on hepatitis B virus.Methods Based on the principle of Hepatitis B immunization decision analytic-Markov model,strategies on PMTCT and universal vaccination were compared.Related parameters of Shenzhen were introduced to the model,a birth cohort was set up as the study population in 2013.The net present value (NPV),benefit-cost ratio (BCR),incremental cost-effectiveness ratio (ICER) were calculated and the differences between CBA and CEA were compared.Results A decision tree was built as the decision analysis model for hepatitis B immunization.Three kinds of Markov models were used to simulate the outcomes after the implementation of vaccination program.The PMTCT strategy of Shenzhen showed a net-gain as 38 097.51 Yuan/per person in 2013,with BCR as 14.37.The universal vaccination strategy showed a net-gain as 37 083.03 Yuan/per person,with BCR as 12.07.Data showed that the PMTCT strategy was better than the universal vaccination one and would end with gaining more economic benefit.When comparing with the universal vaccination program,the PMTCT strategy would save 85 100.00 Yuan more on QALY gains for every person.The PMTCT strategy seemed more cost-effective compared with the one under universal vaccination program.In the CBA and CEA hepatitis B immunization programs,the immunization coverage rate and costs of hepatitis B related diseases were the most important influencing factors.Outcomes of joint-changes of all the parameters in CEA showed that PMTCT strategy was a more cost-effective.Conclusions The PMTCT strategy gained more economic benefit and effects on health.However,the cost of PMTCT strategy was more than the universal vaccination program,thus it is important to pay attention to the process of PMTCT strategy and the universal vaccination program.CBA seemed suitable for strategy optimization while CEA was better for strategy evaluation.Hopefully,programs as combination of the above said two methods would facilitate the process of economic evaluation.
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<p><b>OBJECTIVE</b>To establish the single genome amplification (SGA) method and analyze the quasispecies in HIV-infected patients.</p><p><b>METHODS</b>All 6 sample RNA acquired in 2010 in Shenzhen and genetic sequenced as overlap peaks were extracted and diluted to a single copy, nest-PCR after one step RT-PCR was employed to amplify HIV-1 genome, and then PCR products was purified and sequenced. Mega 4.02 software was used to analyze the genetic distance among HIV-1 quasispecies, and phylogenetic tree was constructed.</p><p><b>RESULTS</b>Our data showed that viral sequences derived from different patients were grouped into different clusters. Subcluster was also observed in several clusters, indicating these existed competition and preferential replication of certain viral strains. The genetic distance within one cluster of 6 samples were between 0.008 and 0.06, it was likely to associate with the duration since infection and viral load.</p><p><b>CONCLUSION</b>SGA is a useful approach to gain information on quasispecies, the genetic distance within one cluster may help to determine the infection time and immune escaping. The analysis of related affecting factors need more samples.</p>
Sujets)
Humains , Séquence nucléotidique , Génome viral , Infections à VIH , VIH-1 (Virus de l'Immunodéficience Humaine de type 1) , Phylogenèse , Réaction de polymérisation en chaîne , RT-PCR , Charge viraleRésumé
Objective: To optimize the Shenzhen universal infant hepatitis B immunization method. Methods: To analyze the long effectiveness of different immunization strategies and disease transition after hepatitis B virus infection by using cost-effectiveness method through decision-tree and Markov models among the Shenzhen newborns cohort in 2010 based on the local parameters. Results:Through the current strategies, the program of screening all pregnant women for HBsAg and vaccinating newborns of single-positive mothers combing with HBIG and vaccine would not only prevent more new cases, hepatic carcinoma and related deaths; but also gain more living years and QALYs. From the social prospect, it will save about RMB 40 million compared with the current program. Conclusion: It is suggested that Shenzhen Government should amend the current universal infant hepatitis B immunization program to gain more economic and social benefits.
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Objective To isolate Hantaviruses from reservoir animals captured in natural epidemic areas of hemorrhagic fever with renal syndrome(HFRS)and genotype isolated strains of Hantavirus in Shenzhen.Methods Infant Meriones unguiculatus and Vero-E6 cells were used in virus isolation and direct immunofluorescence assay was used for identifying viruses.The G1,G2 fragments of M segment and S segment were amplified with reverse transcription-nested-polymerase chain reaction(RT-nested-PCR)by using the Hantavirus genotype specific primers.The amplified genes were then sequenced,and subjected to homology and cladogram analysis.Results Two virus strains were isolated successfully and designated as SZ2082 and SZ2083 from Rattus norvegicus captured in Shenzhen and were identified as SEOV type by RT-nested-PCR.The nucleotide sequences of partial M and S segmentS of SZ2082 were consistent with SZ2083 completely.Compared with the G1 and G2 fragments of M gene of SEOV80-39 virus strain,the homologies of nucleotide among them were 96.7% and 95.0%,but the homology were 75.9% and 70.3% of the Hantaviruses strain with HTNV76-118 virus strain,respectively.The homology of S gene with SEOV80-39 and HTNV76-118 showed 95.7% and 69.7% at nucleotide level.The results were similar to that of M genome segment.SZ2082 and BjFT01,Beijing Rn,Guangl99,HN71-L were on the same branch and their homology reached up to 99.0%-99.7%.Conclusions Hantaviruses are isolated from Shenzhen for the first time and are classified as S2 subtype of Seoul virus.
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<p><b>OBJECTIVE</b>To study the role of dietary and nutritional factors in the etiology of urolithiasis.</p><p><b>METHODS</b>Two hundred and fourty-one pairs of urolithiasis patients and controls were selected, and matched on age and sex, and without having urinary, endocrine, metabolic, or other related diseases. Subjects were given with a standardized semi-quantitative questionnaire to inquire their demographic features and diet information. Data were analyzed according to their respective property. Conditional logistic regression were used to compute odds ratio and 95% confidence interval.</p><p><b>RESULTS</b>The following variables were found to have significant in single factor logistic regression analysis: do not fond of drinking water [OR(no:yes) = 1.914 (95% CI: 1.272 - 2.881)]; drinking less purified water [OR(once:more) = 0.771 (95% CI: 0.614 - 0.967)]; drinking less liquid [OR(one cup more) = 0.273 (95% CI: 0.076 - 0.978)]; eating salted food [OR(highest:common) = 3.382 (95% CI: 2.133 - 5.362), OR(higher:common) = 1.435 (95% CI: 1.252 - 1.645)]; fond of sweet food [OR(most:no) = 4.509 (95% CI: 2.457 - 8.277), OR(more:no) = 1.562 (95% CI: 1.305 - 1.870)]; intake of animal oil [OR(yes:no) = 2.222 (95% CI: 1.012 - 4.880)]; over intake of protein, fat and phosphorus; less intake of carbohydrate, dietary fibre and vitamin C.</p><p><b>CONCLUSION</b>Results indicated that dietary and nutritional factors were important risk factors to the etiology of urinary calculi.</p>
Sujets)
Humains , Acide ascorbique , Études cas-témoins , Régime alimentaire , Consommation de boisson , Modèles logistiques , Phénomènes physiologiques nutritionnels , Facteurs de risque , Calculs urinairesRésumé
<p><b>OBJECTIVE</b>To determine the risk factors of urinary calculi in Shenzhen for proper interventions.</p><p><b>METHODS</b>A population-based case-control study including 334 urinary calculi cases and 721 controls was carried out. A total number of 34 factors were analyzed using unconditional logistic regression.</p><p><b>RESULTS</b>Seventeen factors were associated with urolithiasis based on the logistic regression analysis. Ten factors entered the last model of the logistic multivariate regression. The more protein consumption (OR = 2.14, 95% CI: 1.71 - 2.69), positive history of first relatives with urolithiasis (OR = 2.61, 95% CI: 1.70 - 4.01), longer outdoor exposure (OR = 1.39, 95% CI: 1.16 - 1.66) and chronic inflammation of urinary system (OR = 4.09, 95% CI: 1.38 - 12.14) were risk factors of urinary calculi. Higher education background (OR = 0.46, 95% CI: 0.29 - 0.73), drinking more water (OR = 0.59, 95% CI: 0.48 - 0.72), drinking more juice (OR = 0.41, 95% CI: 0.18 - 0.94), more milk and milk product consumption (OR = 0.82, 95% CI: 0.68 - 0.99), vegetable (OR = 0.70, 95% CI: 0.55 - 0.91) and fruit consumption (OR = 0.78, 95% CI: 0.64 - 0.94) were protective factors of urolithiasis.</p><p><b>CONCLUSION</b>Dietary habits were the major influencing factors of urinary calculi. Positive history of family with urolithiasis and social-economic factors were also associated with the disease.</p>