湖南省备孕和孕初妇女叶酸增补优化策略的效果模拟

doi:10.3969/j.issn.1006-3110.2023.02.015

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摘要目的评估湖南省备孕和孕初妇女叶酸食物增补优化策略的成本效果和成本效益,为政府决策及相关防控策略的制定提供科学依据。方法在湖南省现行推广口服叶酸片政策的基础上,推荐未服用叶酸片的备孕妇女食用叶酸强化的免淘洗大米,并设置不同覆盖范围,以政府数据和既往文献为数据来源计算不同方案的成本效果比、增量成本效果比、净效益和成本效益比率。结果湖南省备孕和孕初妇女增补叶酸优化方案不同覆盖范围的总成本为3 611.4～4 273.6万元,可减少神经管缺陷病例218～222例,总效益达65 020.7～66 213.7万元。现行推荐湖南省备孕和孕初妇女服用叶酸片预防神经管缺陷的成本效果比最低,每避免1例神经管缺陷患者的成本为15.7万元。在优化方案下,每多避免1例神经管缺陷患者的平均成本至少为110.4万元。优化方案净效益高于原方案,然而随着叶酸强化的免淘洗大米覆盖率增加,成本效益比率逐渐下降。结论口服叶酸片仍是具有较好的成本效果比和成本效益比的神经管缺陷预防策略,推广叶酸强化的免淘洗大米可以提高神经管缺陷预防的总效果和总效益,可针对重点人群进行推广。

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	杨蕾
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	胡国清

关键词 ：备孕, 初孕, 叶酸, 神经管缺陷, 食品强化, 卫生经济学

Abstract：Objective To evaluate the cost-effectiveness and cost-benefit of an optimization strategy of folic acid food fortification for women planning pregnancy or in early pregnancy in Hunan Province, and to provide a scientific basis forgovernment decision-making and formulating relevant prevention and control strategies. Methods Based on the current policy of folic acid supplementation in Hunan Province, folic acid fortified washing-free rice was recommended for women without oral administration of folic acid tablets during preparation for and early stages of pregnancy. With different coverage rates, cost-effectiveness ratio, incremental cost-effectiveness ratio, net benefit and cost-benefit ratio were calculated using data from government and literature review. Results The total costs of the folic acid food fortification optimization strategy with different coverage rates in women planning pregnancy or in early pregnancy in Hunan Province were 36.114-42.736 million Yuan, avoiding 218-222 cases of neural tube defects (NTDs), and the total benefits reached 650.207-662.137 million Yuan. Current policies that recommended women take folic acid tablets to prevent NTDs had the lowest cost-effectiveness ratio, with 157 thousand Yuan per case. In theoptimization strategy, the average cost of reducing one additional case of NTDs was least 1.104 million Yuan. The net benefit of the optimized strategies was higher than that of the original policy; however, the cost-effectiveness ratio decreased gradually as the coverage rate of folic acid fortified washing-free rice increased. Conclusion Oral administration of folic acid tablets is still an optimal NTDs prevention strategy with a lower cost-effectiveness ratio and higher cost-benefit ratio. Popularizing folic acid fortified washing-free rice can improve the total effect and net benefit of NTDs prevention, and it can be promoted among the key group.

Key words： pregnancy preparation early pregnancy folic acid neural tube defect food fortification health economics

收稿日期: 2022-03-24

R153.1

通讯作者: 胡国清,E-mail:huguoqing009@csu.edu.cn。

作者简介: 杨蕾(1997-),女,宁夏银川人,硕士在读,研究方向:伤害流行病学、大数据、统计建模。

引用本文:

杨蕾, 李影子, 华俊杰, 成佩霞, 胡国清. 湖南省备孕和孕初妇女叶酸增补优化策略的效果模拟[J]. 实用预防医学, 2023, 30(2): 190-193. YANG Lei, LI Ying-zi, HUA Jun-jie, CHENG Pei-xia, HU Guo-qing. Simulation of economical effectiveness of an optimization strategy
of folic acid food fortification for women during preparation for and
early stages of pregnancy in Hunan Province. , 2023, 30(2): 190-193.

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https://www.syyfyx.com/CN/10.3969/j.issn.1006-3110.2023.02.015 或 https://www.syyfyx.com/CN/Y2023/V30/I2/190

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