2015—2022年西藏棘球蚴病人群筛查和患者治疗成本效果分析

doi:10.12140/j.issn.1000-7423.2025.01.008

中国寄生虫学与寄生虫病杂志 ›› 2025, Vol. 43 ›› Issue (1): 44-51.doi: 10.12140/j.issn.1000-7423.2025.01.008

2015—2022年西藏棘球蚴病人群筛查和患者治疗成本效果分析

雷家希¹(), 贡桑曲珍², 王立英¹^,^*()(), 杨频¹, 程茜茜¹, 王芝依¹, 姜明哲¹

1 中国疾病预防控制中心寄生虫病预防控制所（国家热带病研究中心）；传染病溯源预警与智能决策全国重点实验室；国家卫生健康委员会寄生虫病原与媒介生物学重点实验室；世界卫生组织热带病合作中心；科技部国家级热带病国际联合研究中心，上海 200025
2 西藏自治区疾病预防控制中心，国家卫生健康委包虫病防治研究重点实验室，西藏拉萨 850000

收稿日期:2024-12-14 修回日期:2025-01-22 出版日期:2025-02-28 发布日期:2025-03-26
通讯作者: *王立英（ORCID：0000-0002-2692-2770），女，博士，研究员，从事流行病与卫生统计学研究。E-mail: wangliyingcdc@163.com
作者简介:雷家希，男，硕士研究生，从事流行病与卫生统计学研究。E-mail：leijiaxi91@163.com
基金资助:
国家卫生健康委包虫病防治研究重点实验室开放课题(2024WZK1001);中国疾病预防控制中心寄生虫病预防控制所科技创新支撑计划(TF2024005)

Cost-effectiveness analysis of population screening and patient treatment for echinococcosis in Xizang from 2015 to 2022

LEI Jiaxi¹(), GONGSANG Quzhen², WANG Liying¹^,^*()(), YANG Pin¹, CHENG Xixi¹, WANG Zhiyi¹, JIANG Mingzhe¹

1 National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention; Chinese Center for Tropical Diseases Research; National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases; Key Laboratory on Parasite and Vector Biology, National Health Commission; WHO Collaborating Centre for Tropical Diseases; National Center for International Research on Tropical Diseases, Ministry of Science and Technology, Shanghai 200025, China
2 Xizang Center for Disease Control and Prevention, NHC Key Laboratory of Echinococcosis Prevention and Control, Lhasa 850000, Xizang, China

Received:2024-12-14 Revised:2025-01-22 Online:2025-02-28 Published:2025-03-26
Contact: *E-mail: wangliyingcdc@163.com
Supported by:
NHC Key Laboratory of Echinococcosis Prevention and Control(2024WZK1001);Science and Technology Innovation Support Program-Tengfei Project (TF2024005) of Parasitic Disease Prevention and Control Institute, Chinese Centre for Disease Control and Prevention

摘要/Abstract

摘要：

目的分析2015—2022年西藏棘球蚴病人群筛查和患者治疗的成本-效果，为制定或调整棘球蚴病防治策略和措施提供参考。方法从西藏自治区包虫病防治工作年报系统收集2015—2022年西藏棘球蚴病人群筛查和患者治疗方面投入的成本、查出新患者数、治疗效果等相关数据。计算各年度、各地区/市的筛查和治疗的成本-效果。用增量成本-效果比（ICER）反映西藏棘球蚴病实际发生的伤残调整寿命年（DALY）与无干预下估算的DALY之间的差异∆E与查治成本∆C之间的关系。ICER与人均国内生产总值（GDP）的比值作为支付意愿阈值（WTP）。不同年份之间治疗总有效率的差异用K-W检验，使用Bonferroni法进行两两比较，并校正P值。结果 2015—2022年西藏在棘球蚴病人群筛查经费投入总成本为5 417.1万元，2017年最高（2 762.4万元）。2017—2022年新发现患者的筛查成本-效果比呈逐年增高趋势，由2017年的1 641元/人升高到2022年的21 131元/人。2022年，日喀则市筛查新发现患者率最高（0.10%），山南市最低（0.00%），相应的筛查成本-效果比分别为1.0万元/人和20.9万元/人。2015—2022年西藏患者治疗投入总成本为8 056.0万元，2018年度最高（3 905.5万元）。其中手术治疗成本占比73.0%（5 880.7万元），药物治疗成本占比27.0%（2 175.4万元）。西藏2015—2022年患者总治愈率为11.1%，治愈率年度变化趋势不明显，好转率呈上升趋势，在2022年达到了68.6%。西藏自治区实际DALY低于无干预情况下的DALY，挽回的DALY损失由2017年的6 293.03增加到了2022年的11 487.84。2017—2022年西藏棘球蚴病人群筛查及患者治疗ICER平均为11 460.3元/年，WTP为0.196。结论西藏2017—2022年棘球蚴病的人群筛查和患者治疗方面投入较大，资金利用效率较高。通过普查，发现了大量处于早期的棘球蚴病患者，并积极安排了手术救治和药物治疗。但目前筛查效率较低的地区已不再适合大规模人群筛查，建议因地制宜地调整筛查策略和方式。在棘球蚴病患者治疗方面，建议加强手术诊疗培训，提高手术水平和效果，加强药物治疗患者的规范管理和服药依从性，进一步提高棘球蚴病患者的救治效果。

关键词: 棘球蚴病, 成本-效果分析, 人群筛查, 患者治疗, 西藏

Abstract:

Objective To analyze the cost-effectiveness of population screening and patient treatment for echinococcosis in Xizang from 2015 to 2022, so as to provide insights into formulation or adjustment of the echinococcosis control strategies and measures. Methods The costs for population echinococcosis screening and echinococcosis patient treatment, newly diagnosed echinococcosis cases, and treatment efficiency in Xizang from 2015 to 2022 were collected from the annual report system of the Hydatid Disease Prevention and Control Program in Xizang Autonomous Region, and the cost-effectiveness of echinococcosis screening and treatment was calculated in each year from 2015 to 2022 and in each prefecture/city. The incremental cost-effectiveness atio (ICER) was used to examine the association of the difference (∆E) between the actual disability-adjusted life years (DALYs) due to echinococcosis and the estimated DALYs without interventions with the total costs of echinococcosis screening and treatment (∆C) in Xizang, and the willingness-to-pay (WTP) threshold was measured as a ratio of ICER to per capita gross domestic product (GDP). The difference in the overall response to treatment was tested for statistical significance with Kruskal-Wallis (K-W) test among years, followed by pairwise comparisons with Bonferroni corrections. Results The total costs of population screening for echinococcosis were 54.171 million yuan in Xizang from 2015 to 2022, with the highest in 2017 (27.624 million yuan). The cost-effectiveness ratio for screening newly detected echinococcosis cases appeared a tendency towards a rise over years from 2017 to 2022, from 1 641 yuan/person in 2017 to 21 131 yuan/person in 2022. The proportion of newly detected echinococcosis cases by screening was highest in Shigatse City (0.10%) and lowest in Shannan City (0.00%) in 2022, and the cost-effectiveness ratios were 10 000 yuan/person and 209 000 yuan/person, respectively. The total costs for echinococcosis patient treatment were 80.560 million yuan in Xizang from 2015 to 2022, peaking in 2018 (39.055 million yuan), including 58.807 million yuan for surgical treatment (73.0%) and 21.754 million yuan for drug treatment (27.0%). The overall cure rate of echinococcosis patients was 11.1% in Xizang from 2015 to 2022, with no significant annual trends in cure rates; however, the proportion of improvements appeared a tendency towards a rise during the study period, with 68.6% in 2022. The actual DALYs due to echinococcosis were lower than the estimated DALYs without interventions in Xizang, and the averted DALYs loss increased from 6 293.03 in 2017 to 11 487.84 in 2022. The average ICER for population echinococcosis screening and patient treatment was 11 460.3 yuan/year in Xizang from 2017 to 2022, with a WTP of 0.196. Conclusion Xizang has given large financial investments and achieved a satisfactory efficiency for population screening and patient treatment of echinococcosis from 2017 to 2022, with a high fund utilization efficiency. Through comprehensive screening, a large number of early-stage echinococcosis patients were identified, and surgical treatments and medication were actively arranged. However, regions with currently low screening efficiency are no longer suitable for large-scale population screening. It is recommended to adjust screening strategies and methods according to local conditions. For the treatment of echinococcosis patients, it is advised to enhance surgical training to improve surgical standards and outcomes, strengthen the standardized management of patients undergoing drug treatment, and improve medication adherence, thereby further enhancing the treatment effectiveness for echinococcosis patients.

Key words: Echinococcosis, Cost effectiveness analysis, Population screening, Patient treatment, Xizang

中图分类号:

R532.32

雷家希, 贡桑曲珍, 王立英, 杨频, 程茜茜, 王芝依, 姜明哲. 2015—2022年西藏棘球蚴病人群筛查和患者治疗成本效果分析[J]. 中国寄生虫学与寄生虫病杂志, 2025, 43(1): 44-51.

LEI Jiaxi, GONGSANG Quzhen, WANG Liying, YANG Pin, CHENG Xixi, WANG Zhiyi, JIANG Mingzhe. Cost-effectiveness analysis of population screening and patient treatment for echinococcosis in Xizang from 2015 to 2022[J]. Chinese Journal of Parasitology and Parasitic Diseases, 2025, 43(1): 44-51.

图/表 5

表1

西藏各地区/市2015—2022年人群筛查和治疗成本

地区 Area		年份 Year	人群筛查 Screening of population													患者治疗 Treatment of patients
地区 Area		年份 Year	筛查村数 No. village screened		筛查地总人口/万人 Population of screening area/10⁴		筛查人数/万 No. people screened/10⁴		新发现患者数/例 No. newly patient screened	患者检出率/% Detection rate of patients/%		筛查成本/万元 Screening cost/10⁴ yuan		筛查成本- 效果比/ 元·人^-1 Screening cost-effectiveness ratio/Yuan·person^-1		总成本/万元 Total cost/10⁴ yuan		药物成本/万元 Drug cost/10⁴ yuan		手术成本/万元 Surgical cost/10⁴ yuan		现有患者数/例 No. patient		治愈数/例 No. cured patient	治愈率/% Cure rate /%		好转数/例 No. patient effectively treated		好转率/% Effective rate/%
拉萨 Lhasa		2015	28		4.65		0.45		10	0.22		4.5		4 502		4.7		1.5		3.2		283		5	1.77		1		0.35
		2016	27		5.49		0.08		17	2.13		0.8		471		8.4		2.8		5.6		17		4	23.53		0		0
		2017	221		34.64		51.93		731	0.14		519.3		7 103		201.4		15.8		185.6		920		191	20.76		183		19.89
		2018	368		50.41		0.20		20	1.02		2.0		981		332.1		31.3		302.5		885		137	15.48		481		54.35
		2019	277		52.81		5.09		44	0.09		50.9		11 569		48.5		21.0		27.5		139		29	20.86		100		71.94
		2020	267		50.92		19.37		39	0.02		193.7		49 659		67.4		9.7		57.6		162		72	44.44		99		61.11
		2021	268		47.88		1.99		22	0.11		19.9		9 055		20.2		7.4		12.8		157		0	0		85		54.14
		2022	272		50.18		2.99		3	0.01		29.9		99 740		23.0		10.2		12.8		156		30	19.23		89		57.05
		小计 Subtotal	1 728		296.98		82.09		886	0.11		820.9		9 265		705.7		99.8		605.9		2 719		468	17.21		1 038		38.18
日喀则 Shigatse		2015	87		3.39		0.38		54	1.42		3.8		706		30.6		8.2		22.4		121		21	17.36		44		36.36
		2016	87		3.43		0.87		37	0.42		8.7		2 361		10.9		5.3		5.6		132		9	6.82		29		21.97
		2017	1 057		45.58		70.33		2 464	0.35		703.3		2 854		354.6		93.0		261.6		2 781		129	4.64		774		27.83
		2018	1 624		57.25		33.06		284	0.09		330.6		11 641		883.4		121.8		761.6		3 233		485	15.00		904		27.96
		2019	1 665		79.68		4.18		139	0.33		41.8		3 006		225.1		184.1		41.1		1 408		50	3.55		1 094		77.70
		2020	1 674		83.29		14.36		169	0.12		143.6		8 496		173.9		96.6		77.3		1 513		163	10.77		861		56.91
		2021	1 675		82.05		9.51		46	0.05		95.1		20 663		51.3		22.2		29.1		1 182		199	16.84		1 037		87.73
		2022	1 680		76.06		4.54		44	0.10		45.4		10 320		51.7		23.4		28.3		1 023		95	9.29		676		66.08
		小计 Subtotal	9 549		430.73		137.23		3 237	0.24		1 372.3		4 239		1 781.6		554.6		1 226.9		11 393		1 166	10.10		5 419		47.56
山南 Shannan		2015	23		2.79		0.85		5	0.06		8.5		16 980		12.6		7.0		5.6		149		52	34.90		80		53.69
		2016	27		2.87		1.34		110	0.82		13.4		1 219		7.6		1.2		6.4		131		13	9.92		13		9.92
		2017	349		23.89		29.98		1 309	0.44		299.8		2 290		144.0		8.8		135.2		1 457		30	2.06		21		1.44
		2018	548		29.88		24.21		33	0.01		242.1		73 358		377.0		58.6		318.4		1 321		301	22.79		761		57.61
		2019	548		29.88		27.01		25	0.01		270.8		108 303		45.8		19.4		26.4		708		58	8.19		133		18.79
		2020	547		31.6		19.83		30	0.02		198.3		66 096		68.6		16.7		51.9		458		62	13.54		110		24.02
		2021	541		28.35		2.63		2	0.01		26.3		131 615		13.1		8.3		4.8		142		210	147.89		139		97.89
		2022	549		28.74		4.19		2	0.00		41.9		209 475		4.4		2.8		1.6		90		3	3.33		78		86.67
		小计 Subtotal	3 132		178.00		110.11		1 516	0.14		1 101.1		7 263		673.1		122.8		550.3		4 456		729	16.36		1 335		29.96
昌都 Chang-du		2015	166		11.42		0.34		16	0.48		3.4		2 094		19.6		13.2		6.4		180		3	1.67		70		38.89
		2016	34		4.60		0.25		110	4.43		2.5		226		14.2		3.0		11.2		183		2	1.09		67		36.61
		2017	910		55.83		62.29		3 942	0.63		622.9		1 580		348.3		205.9		142.4		4 466		36	0.81		1 105		24.74
		2018	1 267		64.19		0.13		24	1.80		1.3		555		655.9		200.7		455.2		2 452		1 020	41.60		815		33.24
		2019	1 139		63.39		2.92		74	0.25		29.2		3 943		401.4		258.5		142.9		2 030		253	12.46		722		35.57
		2020	1 103		74.39		6.17		82	0.13		61.7		7 525		217.5		159.5		58.2		1 702		83	4.88		1 441		84.67
		2021	1 100		72.25		9.33		23	0.02		93.3		40 554		45.0		17.4		27.6		1 630		133	8.16		1 617		99.20
		2022	1 106		72.90		4.63		13	0.03		46.3		35 639		45.4		36.6		8.8		1 430		125	8.74		1 261		88.18
		小计 Subtotal	6 825		418.97		86.05		4 284	0.50		860.5		2 009		1 747.3		894.8		885.5		14 073		1 655	11.76		7 098		50.44
那曲 Nagqu	2015			214	8.44	0.16		44			2.84		1.6		352		26.5		9.7		16.8	298	32			10.74		1		0.34
	2016			157	5.76	0.68		85			1.26		6.8		795		56.7		6.3		50.4	116	31			26.72		66		56.90
	2017			1 172	48.77	41.61		7 545			1.81		416.1		552		393.3		66.1		327.2	7 630	63			0.83		798		10.46
	2018			1 185	43.58	2.87		522			1.82		28.7		550		1 342.8		86.0		1 256.8	5 514	1 131			20.51		3 393		61.53
	2019			1 187	47.06	5.59		88			0.16		55.9		6 349		249.2		72.4		176.8	2 684	375			13.97		763		28.43
	2020			1 190	50.54	3.86		41			0.11		38.6		9 413		187.8		73.4		114.4	1 826	203			11.12		856		46.88
	2021			1 190	50.27	8.91		115			0.13		89.1		7 744		124.8		37.2		87.6	2 169	0			0		1 210		55.79
	2022			1 190	51.68	2.51		15			0.06		25.1		16 718		47.9		24.9		23.0	1 814	125			6.89		1 031		56.84
	小计 Subtotal			7 485	306.10	66.17		8 455			1.28		661.7		783		2 429.0		376.0		2 053.0	22 051	1 960			8.89		8 118		36.81
林芝 Linzhi	2015			60	5.90	1.70		12			0.07		17.0		14 166.7		0.6		0.6		0	12	4			33.33		0		0
	2016			4	5.52	1.75		3			0.02		17.5		58 250.0		2.7		2.7		0	8	0			0		3		37.50
	2017			508	18.96	17.04		344			0.20		170.4		4 954.5		124.5		4.5		120.0	344	150			43.60		240		69.77
	2018			509	14.85	0.52		125			2.39		5.2		418.5		229.5		18.3		211.2	659	187			28.38		187		28.38
	2019			491	14.99	9.94		18			0.02		99.4		55 204.4		46.8		14.8		32.0	277	67			24.19		55		19.86
	2020			491	22.76	1.14		16			0.14		11.4		7 099.4		30.9		7.7		23.2	224	68			30.36		91		40.63
	2021			498	23.89	1.84		4			0.02		18.4		45 897.5		7.2		3.2		4.0	223	6			2.69		86		38.57
	2022			498	23.90	1.48		13			0.09		14.8		11 379.2		6.2		4.6		1.6	200	31			15.50		112		56.00
	小计 Subtotal			3 059	130.77	35.40		535			0.15		354.0		6 616.8		448.5		56.5		392.0	1 947	513			26.35		774		39.75
阿里 Ali	2015			48	2.22	0.24		148			6.09		2.4		164.2		7.6		5.2		2.4	148	0			0		0		0
	2016			47	2.70	0.79		33			0.42		7.9		2 406.4		6.4		2.4		4.0	75	25			33.33		25		33.33
	2017			98	4.91	8.70		1 054			1.21		87.0		825.0		128.9		20.9		108.0	1 186	97			8.18		268		22.60
	2018			144	10.31	2.06		40			0.19		20.6		5 143.8		84.8		16.8		68.0	919	94			10.23		430		46.79
	2019			144	10.93	2.42		56			0.23		24.2		4 312.3		17.7		10.5		7.2	618	42			6.80		154		24.92
	2020			144	11.97	3.15		80			0.25		31.5		3 935.6		19.8		10.1		9.6	624	40			6.41		323		51.76
	2021			140	11.24	0.91		11			0.12		9.1		8 310.0		4.5		3.7		0.8	516	3			0.58		272		52.71
	2022			141	11.07	1.42		13			0.09		14.2		10 940.8		1.3		1.3		0	281	11			3.91		178		63.35
	小计 Subtotal			906	65.35	19.69		1 435			0.73		196.9		1 372.0		270.9		70.9		200.0	4 367	312			7.14		1 650		37.78
总计 Total	2015			626	38.81	4.11		289			0.70		41.1		1 423		102.1		45.3		56.8	1 191	117			9.82		196		73.39
	2016			383	30.37	5.76		395			0.69		57.6		1 458		106.8		23.6		83.2	662	84			12.69		203		16.46
	2017			3 682	243.07	276.24		16 829			0.61		2 762.4		1 641		1 695.1		415.1		1 280.0	18 124	600			3.31		3 125		30.66
	2018			5 645	270.47	63.05		1 048			0.17		630.5		6 016		3 905.5		533.5		3 372.0	14 983	3 354			22.39		6 950		17.24
	2019			5 422	298.75	57.20		444			0.08		572.0		12 883		1 034.5		580.6		453.9	7 891	874			11.08		3 021		46.39
	2020			5 416	325.47	67.87		457			0.07		678.7		14 851		765.9		373.9		392.0	6 509	691			10.62		3 781		38.28
	2021			5 412	315.93	45.71		250			0.06		457.1		18 285		266.1		99.5		166.7	6 019	551			9.15		4 446		58.09
	2022			5 436	314.53	21.76		103			0.05		217.6		21 131		180.0		103.9		76.1	4 994	420			8.41		3 425		73.87
	合计 Total			32 022	1 837.40	541.71		19815			0.37		5 417.1		2 734		8 056.0		2 175.4		5 880.7	60 373	6 691			11.08		25 147		41.65

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参考文献 24

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各地区/市 Region/City	总成本/万元 Total cost/10⁴ yuan	挽回DALY损失/（人·年） Recovering DALY/(Person·year)	ICER/元 ICER/Yuan	2022年人均GPD/元 Per capita GDP in 2022/Yuan	支付意愿衡量指标 Willingness-to-pay threshold
拉萨 Lhasa	1 526.6	1 279.15	11 934.5	85 931	0.139
日喀则 Shigatse	3 153.8	3 150.40	10 010.8	45 238	0.221
山南 Shannan	1 774.2	764.27	23 214.3	69 429	0.334
昌都 Changdu	2 607.8	2 260.66	11 535.6	39 250	0.294
那曲 Nagqu	3 090.7	1 551.29	19 923.4	38 640	0.516
林芝 Linzhi	802.5	574.80	13 961.4	86 792	0.161
阿里 Ali	467.8	2 096.85	2 231.0	67 083	0.033
合计 Total	13 165.4	11 487.84	11 460.3	58 438	0.196

2015—2022年西藏棘球蚴病人群筛查和患者治疗成本效果分析

Cost-effectiveness analysis of population screening and patient treatment for echinococcosis in Xizang from 2015 to 2022

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