2016－2022年江苏、浙江、上海三省份耐药结核病防治工作效果的监测分析

王泊宁; 阮云洲; 竺丽梅; 陈彬; 沈鑫; 赵雁林; 陈伟

doi:10.3784/jbjc.202308090407

2016－2022年江苏、浙江、上海三省份耐药结核病防治工作效果的监测分析

Performance of prevention and treatment of drug-resistant tuberculosis in Jiangsu, Zhejiang and Shanghai, 2016−2022

摘要

摘要:
目的了解2016—2022年江苏、浙江、上海三省份（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.

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