摘要
目的 以多中心HIV残余风险研究为基础,分析不同HIV检测策略的成本与效果,为血站采用适宜的HIV检测策略提供参考依据.方法 依据安徽省3家血站献血者HIV检测、确认情况,估算HIV不同检测方法的残余风险.建立决策树模型,分析国内现行政策下的3种不同检测策略的成本效果差异.结果 本研究调查地区,抗-HIV-1+2 ELISA、HIVAg/Ab1+2 ELISA、ELISA+NAT技术的残余风险分别为 1.17×10-6、0.84×10-6、0.59×10-6;经决策树模型分析,在无核酸检测时,HIVAg/Ab1+2 ELISA较抗-HIV-1+2 ELISA方案更具成本效果优势,但加上1遍NAT后,HIV Ag/Ab1+2 ELISA的优势消失;HIV试剂成本、HIV治疗成本以及假阳性报废成本,是模型的敏感因素.结论 本研究调查地区,采用1遍抗HIV-1+2 ELISA加1遍NAT方案,具有成本效果优势.血站在决定采用何种HIV检测策略前,需对使用的酶免试剂,进行确认和评估,在保证灵敏度的前提下,综合考虑关键因素为试剂成本及试剂假阳性率.
Abstract
Objective To analyze the cost and effectiveness of different HIV screening strategies based on multi-center HIV residual risk study,so as to provide reference for blood centers to adopt appropriate HIV testing strategies.Methods According to the HIV screening and confirmation of blood donors in three blood centers in Anhui Province,the residual risk of different HIV screening strategies was estimated.A decision tree model was established to analyze the cost-effectiveness differences of three different screening strategies under current domestic policies.Results The re-sidual risk of anti-HIV-1+2 ELISA,HIV Ag/Ab1+2 ELISA and ELISA+NAT were 1.17×10-6,0.84×10-6 and 0.59×10-6,re-spectively.According to decision tree model analysis,HIV Ag/Ab1+2 ELISA had a cost-effectiveness advantage over an-ti-HIV 1+2 ELISA when there was no NAT,but the advantage of HIV Ag/Ab1+2 ELISA disappeared when there was one NAT.The cost of HIV reagents,the cost of HIV treatment and the cost of false positive discarding were sensitive fac-tors of the model.Conclusion In this area,one anti-HIV 1+2 ELISA combined with one NAT has a cost-effectiveness advantage.Blood centers need to confirm and evaluate the ELISA reagents used before conducting HIV screening.Un-der the premise of ensuring sensitivity,reagent cost and reagent false positive rate are the key factors.
维普
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