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目的:科学评价浙江省实施计划免疫工作三十年来取得的成绩,进一步提高资源配置及服务效率,促进免疫规划工作的可持续发展。方法:以项目分摊方法开展对省、市及8个样本县计划免疫投入成本调研,采用ARIMA模型(Autoregressive Integrated Moving Average Model,自回归移动平均模型)拟合脊灰、麻疹等7种疫苗针对传染病理论发病水平,结合专家论证测算疾病负担和经济效益,再用成本效果分析(Cost Effectiveness Analysis,CEA)、成本效益分析(Cost Benefit Analysis,CBA)和成本效用分析(Cost Utility Analysis,CUA)等开展评价。结果:实施计划免疫工作三十年来,浙江省减少脊灰、麻疹等7种疫苗针对传染病发病5 645 087人、减少死亡190 748人,取得的效益合计为19.14亿元,浙江省计划免疫三十年的成本效果比(CEA)为每万元:减少67人发病及减少2人死亡、成本效益比(CBA)为1∶21.31、成本效用比(CUA)为1万元:70.63DALY,分病种评价中各项指标均麻疹最高。结论:自1978年实施计划免疫工作以来,浙江省有效控制了各种疫苗针对性传染病,取得了巨大的社会经济效益。为做好免疫规划工作的可持续发展,建议继续建立稳定的筹资与投入保障机制,并着重加强麻疹等成本效益显著疾病的防控工作并适时扩大免疫规划。
OBJECTIVE: To scientifically evaluate the achievements made by Zhejiang Province in carrying out planned immunization over the past 30 years, to further improve the resource allocation and service efficiency and to promote the sustainable development of immunization planning. Methods: The cost allocation of planned immunization to provincial, municipal and 8 sample counties was investigated by project apportionment method. Seven kinds of vaccines including polio and measles were fitted to infection by ARIMA model (Autoregressive Integrated Moving Average Model) Pathology, the incidence of disease, combined with the expert argument to calculate the disease burden and economic benefits, and then use cost effectiveness analysis (Cost Effectiveness Analysis, CEA), cost benefit analysis (Cost Benefit Analysis, CBA and Cost Utility Analysis CUA Carry out evaluation. Results: In the past 30 years since the implementation of the planned immunization work, 7 kinds of vaccines for alleviating polio and measles in Zhejiang Province targeted 5 645 087 infectious diseases and 190 748 persons died, with a total benefit of 1.914 billion yuan, The cost to benefit (CBA) was 1:21.31 and the cost-effective ratio (CUA) was $ 10,000: 70.63DALY in 10 years Measles disease in the indicators were the highest measles. Conclusion: Since the implementation of planned immunization in 1978, Zhejiang Province has effectively controlled various vaccines against sexually transmitted diseases and achieved tremendous socio-economic benefits. In order to do a good job in the sustainable development of immunization programs, it is proposed to continue establishing a stable funding and input guarantee mechanism and to focus on prevention and control of cost-effective diseases such as measles and expand immunization programs in a timely manner.