Performance of prevention and treatment of drug-resistant tuberculosis in Jiangsu, Zhejiang and Shanghai, 2016−2022
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摘要:
目的 了解2016—2022年江苏、浙江、上海三省(江浙沪)耐药结核病防治工作开展情况,分析其产生的社会效益。 方法 收集“结核病信息管理系统”中2016—2022年江浙沪地区耐药结核病患者的筛查、治疗及转归信息,采用描述性流行病学方法进行分析。 收集中央转移支付经费和各省财政专项经费中的耐药结核病经费投入以及人均国内生产总值等数据。 使用耐药筛查率、纳入治疗率和治疗成功率对耐药结核病防治工作开展情况进行评价,使用成本–效果比、成本–效用比、效益–成本比对耐药结核病防治工作效果进行评价。 结果 2016—2022年江浙沪地区新病原学阳性患者耐药筛查率为86.00%,高危人群患者耐药筛查率为87.90%;登记的耐药结核病患者纳入治疗率为75.47%,患者治疗成功率为63.32%,7年间前述的4个指标总体呈上升趋势(趋势χ2=129.579,P<0.001;趋势χ2=35.369,P<0.001;趋势χ2=27.711,P<0.001;趋势χ2=10.556,P<0.001);2016—2022年,江浙沪地区共投入耐药结核病防治资金2.66亿元,成功治疗了耐药结核病患者共3570例,挽回了37624.23个伤残调整寿命年(DALY),挽回的社会经济价值41.97亿元;每投入7459.72(4973.15~12432.87)元,可避免1名健康人被传染;每投入7078.20元,可挽回1个DALY损失;每投入1元钱,可产生15.76(14.94~16.79)元的效益。 结论 2016—2022年,江浙沪地区耐药筛查率、纳入治疗率和治疗成功率均高于全国平均水平;江浙沪地区对耐药结核病防治工作的经费投入获得了较高的经济效益,建议政府要继续加大耐药结核病防治工作经费的投入。 Abstract:Objective To evaluate the performance of drug-resistant tuberculosis (TB) prevention and treatment and analyze its social benefits in Jiangsu, Zhejiang and Shanghai from 2016 to 2022. Methods The information about screening, treatment of drug-resistant TB patients were collected from National Tuberculosis Information Management System. The information about investment of central and local government and relevant data, such as gross domestic product per capita, were collected. The screening rate, treatment inclusion rate and the cure rate of drug resistant TB was used to evaluate the performance of the prevention and control of drug-resistant TB. Cost-effectiveness, cost-utility, and cost-benefit were analyzed to evaluate the effectiveness of drug-resistant TB prevention and treatment efforts from 2016 to 2022. Results The screening rate of drug-resistant TB in Jiangsu, Zhejiang and Shanghai from 2016 to 2022 was 86.00% in new etiologic positive patients, 87.90% in patients at high risk. The treatment inclusion rate of drug-resistant TB patients was 75.47%, and the cure rate of drug resistant TB patients was 62.32%. The above four indicators all showed increases during the 7-year period (trend χ2=129.5793, P<0.001, trend χ2=35.3692, P<0.001, trend χ2=27.7113, P<0.001, trend χ2=10.5556, P<0.001). From 2016 to 2022, Jiangsu, Zhejiang and Shanghai invested a total of 0.26 billion yuan for drug-resistant TB prevention and treatment, and 3570 drug-resistant TB patients were successfully treated, reducing 37624.23 disability adjusted life years (DALYs) and 4.197 billion yuan of social and economic losses. An investment of 7459.72 (4973.15−12432.87) yuan can reduce 1 infection, an investment of 7078.20 yuan can reduce 1 DALY and an investment of 1 yuan can produce economic benefit of 15.76 yuan (14.94−16.79). Conclusion During 2016−2022, the screening rate, treatment inclusion rate and cure rate of drug-resistant TB patients in Jiangsu, Zhejiang and Shanghai were higher than the average levels in China. The financial investment in drug-resistant tuberculosis prevention and treatment in Jiangsu, Zhejiang and Shanghai has gained high economic benefits, and it is recommended to continue increasing the investment for drug-resistant TB prevention and treatment. -
表 1 2016-2022年江苏、浙江、上海三省耐药患者筛查和纳入治疗情况
Table 1. Screening and inclusion of drug-resistant tuberculosis patients in Jiangsu, Zhejiang and Shanghai from 2016 to 2022
年份 新病原学阳性患者 高危人群 登记患者数(例) 纳入治疗数(例) 纳入治疗率(%) 应筛查人数(例) 耐药筛查人数(例) 筛查率(%) 应筛查人数(例) 耐药筛查人数(例) 筛查率(%) 2016 19779 9844 49.77 5725 4152 72.52 854 559 65.46 2017 19061 13562 71.15 7102 5506 77.53 1411 610 43.23 2018 27158 25012 92.10 7424 6974 93.94 1315 1016 77.26 2019 28496 27298 95.80 6182 6057 97.98 1241 1009 81.31 2020 27134 26407 97.32 5460 5396 98.83 1201 1091 90.84 2021 28133 25438 90.42 5455 4529 83.02 1333 1118 83.87 2022 19730 18193 92.21 3596 3375 93.85 762 723 94.88 合计 169491 145754 86.00 40944 35989 87.90 8117 6126 75.47 表 2 2016-2022年江苏、浙江、上海三省耐药结核病患者的治疗转归情况
Table 2. Treatment outcomes of drug-resistant tuberculosis patients in Jiangsu, Zhejiang and Shanghai from 2016 to 2022
年份 治疗患者数(例) 治愈人数(例) 完成治疗数(例) 成功治疗数(例) 治疗成功率(%) 2016 612 204 105 309 50.49 2017 514 192 67 259 50.39 2018 556 248 104 352 63.31 2019 699 293 143 436 62.37 2020 1096 481 256 737 67.24 2021 1070 447 220 667 62.34 2022 1091 563 247 810 74.24 合计 5638 2428 1142 3570 63.32 表 3 2016-2022年江苏、浙江、上海三省耐药结核病防治工作投入的社会成本估算情况
Table 3. The social cost of investment in the prevention and treatment of drug-resistant tuberculosis in Jiangsu, Zhejiang and Shanghai from 2016 to 2022
年份 省财政专项经费中耐药结核病投入经费
(万元)中央转移支付经费中用于耐药结核病防治经费
(万元)社会成本(万元) 2016 2274.10 537.00 2811.10 2017 2081.30 723.00 2804.30 2018 2493.30 864.00 3357.30 2019 3530.10 1946.00 5476.10 2020 2230.80 1531.00 3761.80 2021 2230.80 1846.00 4076.80 2022 2230.80 2113.00 4343.80 合计 17071.20 9560.00 26631.20 表 4 2016-2022年江苏、浙江、上海三省耐药结核病防治工作的社会效果和社会效用估算
Table 4. The social effect and social utility of drug-resistant tuberculosis prevention and control in Jiangsu, Zhejiang and Shanghai from 2016 to 2022
年份 成功治疗的传染性耐药结核病患者数[a](例) 避免传染的健康人数[d](社会效果)(例) 挽救的伤残调整寿命年 [f](社会效用)(年) 2016 309 3090(1854~4635) 3256.55 2017 259 2590(1554~3885) 2729.60 2018 352 3520(2112~5280) 3709.73 2019 436 4360(2616~6540) 4595.00 2020 737 7370(4422~11055) 7767.24 2021 667 6670(4002~10005) 7029.51 2022 810 8100(4860~12150) 8536.59 合计 3570 35700(21420~53550) 37624.23 注:d=a×e,e为成功治疗1例传染性耐药结核病患者可以避免受到传染的健康人数,取值为10(6~15),得出避免传染的健康人数d的值。f=a×g,g为治愈1例耐药结核病患者挽救的DALY损失(10.539年) 表 5 2016-2022年江苏、浙江、上海三省耐药结核病防治工作的直接效益和间接效益估算
Table 5. The direct and indirect benefits of drug-resistant tuberculosis prevention and control in Jiangsu, Zhejiang and Shanghai from 2016 to 2022
年份 避免传染的健康人数[d] 直接社会效益[h]
(万元)挽救的伤残调整寿命年[f]
(年)间接社会效益[l]
(万元)2016 3090(1854~4635) 4749.33(2849.60~7124.00) 3256.55 23568.71 2017 2590(1554~3885) 3980.83(2388.50~5971.25) 2729.60 21388.42 2018 3520(2112~5280) 5410.24(3246.14~8115.36) 3709.73 32030.37 2019 4360(2616~6540) 6701.32(4020.79~10051.98) 4595.00 42268.20 2020 7370(4422~11055) 11327.69(6796.61~16991.54) 7767.24 74731.91 2021 6670(4002~10005) 10251.79(6151.07~15377.69) 7029.51 75440.04 2022 8100(4860~12150) 12449.7(7469.82~18674.55) 8536.59 95398.69 合计 35700(21420-53550) 54870.9(32922.54~82306.35) 37624.23 364826.34 注:h=d×k×j,k为感染耐药结核病的发病概率(10%),j为避免一例耐药结核病患者的节约的费用(15.37万元),由于d为范围值,计算得出直接社会效益的范围。l=f×n×人均GDP,n为耐药结核病患者劳动力人口比例(81.10%) 表 6 2016-2022年江苏、浙江、上海三省耐药结核病防治工作的投入产出情况分析
Table 6. The input-output analysis of drug-resistant tuberculosis prevention and control in Jiangsu, Zhejiang and Shanghai from 2016 to 2022
年份 成本–效果a(元/人) 成本–效用b(元/DALY) 效益–成本c(元) 2016 9097.41(6064.94~15162.35) 8632.14 10.07(9.40~10.92) 2017 10827.41(7218.28~18045.69) 10273.66 9.05(8.48~9.76) 2018 9537.78(6358.52~15896.31) 9049.99 11.15(10.51~11.96) 2019 12559.86(8373.24~20933.10) 11917.51 8.94(8.45~9.55) 2020 5104.21(3402.80~8507.01) 4843.16 22.88(21.67~24.38) 2021 6112.14(4074.76~10186.91) 5799.55 21.02(20.01~22.28) 2022 5362.72(3575.14~8937.86) 5088.45 24.83(23.68~26.26) 平均值 7459.72(4973.15~12432.87) 7078.20 15.76(14.94~16.79) 注:a. 成本–效果= p/d,p为社会成本,d为避免传染的健康人数;b. 成本-效用= p/f,f为挽救的伤残调整寿命年;DALY. 伤残调整寿命年;c. 效益–成本=o/p,o为社会效益 -
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