Objective: To evaluate the cost-utility of different immunization strategies for rabies in China, and to provide a reference for determining the optimal immunization strategy. Methods: The system dynamics model was used to simulate the epidemic of canine rabies and a decision tree model was conducted to analysis different immune strategies. Relevant probabilities were obtained through literature search and on-site investigation. Sensitivity analysis was used to explore the important influenced factors. Results: At baseline, from a social perspective, 70% vaccination of dogs was the optimal strategy compared to current vaccination strategy (43% vaccination in dogs, human category-Ⅱ exposure vaccination/category-Ⅲ exposure vaccination combined with RIG). The total cost was 14 084 354 CNY, and the total utility value was 22 078 616.23 QALYs, and the incremental cost-utility ratio was-62 148 147 CNY/QALY; if human vaccination was considered, 55% vaccination of dogs combined with strategy one was the optimal strategy, its incremental cost-utility ratio was-444 620 557 CNY/QALY. The probability that an injured dog carries rabies virus was the most sensitive parameter. When it was greater than 0.005 03, strategy four was the optimal strategy. When it was less than 82/100 000, strategy one was the optimal strategy; when it was between 82/100 000 and 120/100 000, strategy two was the optimal strategy; when it was between 120/100 000 and 503/100 000, strategy two was the optimal strategy. Conclusion: It was conducive to increase the vaccination coverage of canine for the prevention and control of rabies.
目的： 评价我国狂犬病不同免疫策略的成本-效用，从而为确定最优免疫策略提供参考依据。 方法： 应用Vensim PLE软件构建犬群传播的动力学模型，TreeAge pro 2011软件构建犬咬伤人群免疫策略的决策树模型。通过文献检索和现场调查获得相关概率以及成本数据。不同犬群疫苗覆盖率情景下人群的免疫策略包括只有Ⅲ级暴露患者接种疫苗（策略一），Ⅱ、Ⅲ级暴露患者均接种疫苗（策略二），只有Ⅲ级暴露患者同时接种疫苗和狂犬病免疫球蛋白（RIG）（策略三），Ⅱ级暴露患者接种疫苗、Ⅲ级暴露患者接种疫苗并联合RIG（策略四）；现况免疫策略为犬群接种疫苗43%覆盖率，人群Ⅱ级暴露接种疫苗/Ⅲ级暴露接种疫苗联合使用RIG。采用增量成本效用比（ICUR）比较不同免疫策略的优劣，采用敏感性分析评估相关参数对结果的影响。 结果： 基线值时，社会角度来看，相对于现况免疫策略，犬群接种疫苗70%覆盖率为最优策略，其总成本为14 084 354元人民币，总效用值为22 078 616.23质量调整寿命年（QALY），增量成本效用比为-62 148 147元人民币/QALY；如果考虑人群接种疫苗，犬群接种疫苗55%覆盖率结合策略一为最优策略，其增量成本效用比为-444 620 557元人民币/QALY。当伤人犬携带狂犬病病毒的概率小于82/100 000时，策略一为最优策略；当概率在82/100 000与120/100 000之间时，策略三为最优策略；当概率在0.001 2~0.005 03之间时，策略二是最优策略；当概率大于503/100 000时，策略四为最优策略。 结论： 提高犬群疫苗接种覆盖率而减少不必要的人用疫苗，可有利于进一步防控狂犬病且节约社会成本。.
Keywords: Costs and cost analysis; Dynamic-decision tree; Immune strategy; Rabies.