Economic Analysis Of The Prevention Andtreatment Monitroring For Chronicinfectious Disease In China

Infectious diseases cause enormous morbidity and mortality world wide. In China, infectious diseases are the third most frequent cause of death. Development of medical technologies results in important progress in infectious disease prevention and control. For decisions on the prevention and control of the infectious disease as well as development of medical technologies, it is of importance to analyze the economic impact of the prevention and control of infectious diseases. The aim of this study was to establish mathematical models to analyze the economic impact of the prevention and control of infectious diseases, taking chronic hepatitis B in China for an example.In Chapter 1, The background, contents, methodologies, and key issues in this study were introduced. The structure of this study was also demonstrated in this chapter.In Chapter 2, The recent literatures in the fields related to this study were reviewed. The review covered the issues of economic burdens of infectious diseases, evaluation tools in the health economics, technology improvement in the prevention and treatment of infectious diseases, production and costs in health industry, diffusion of new technologies, evaluation of new technologies, and current status of the prevention and control of infectious diseases in China. This review provided sufficient background data for this study.In Chapter 3, Models to analyze the spread of infectious diseases and the disease burden of chronic infectious diseases were established, respectively. The models were able to estimate the numbers of infected, susceptible, and healthy individuals in a certain population, as well as the economic burden of the infectious disease. The estimated direct economic burden of China in the year of 2007 was 36.7 billion RMB. Without immunization programme, the birth cohort of China in 2007 would result in a loss of 115.4 billion RMB in their future lives. Besides, the relation between economy development and incidence of infectious diseases was analyzed in this chapter.In Chapter 4, A model to analyze the economic impact of vaccine immunization was developed. Using the newly published data of a survey on chronic hepatitis B covering the whole China, we analyzed the economic impact of hepatitis B vaccine immunization in China by the tools of cost-effect analysis, cost-benefit analysis, and cost-utility analysis. The results showed that hepatitis B vaccine immunization in China had a great economic effect and saved 5 billion RMB direct medicare costs annually.In Chapter 5, Models to evaluate the economic impact of technologies for monitoring therapies, including a model for determination of the best timing of monitoring, models for selection of best strategy when quantitative or qualitative technologies were used for monitoring the therapy, and a model for comparison of different monitoring strategies were established. These models were used to determine the best timing for monitoring lamivudine therapy in chronic hepatitis B patients, and revealed that monitoring of lamivudine-resistance by new medical technology would save 500 million RMB annually.In the last chapter the following conclusions were reached: 1) Currently, the incidence of infectious diseases is correlated significantly with the Gross Domestic Product (GDP) and the public expenditure, while the death per 100 patients is significantly correlated with rural Engel's coefficient; 2) China has a great economic burden of infectious diseases, and universal vaccine immunization is a cost effective strategy for prevention of the infectious diseases; 3) Using Markov decision models and incremental cost-effective models established in this study is able to analyze and estimate the economic burden of diseases and the impact of medical technologies; 3) China has a very great economic burden of chronic hepatitis B. Universal vaccine immunization and monitoring of therapy will significantly save the health care costs.We also made comments on the policies about the prevention and control of infectious diseases and the development of medical technologies.Innovations in this studyStudies on the economic analysis of health care technologies are in its infancy here in China, and many theoretical and practical issues need to be explored. This study provided mathematical models in accordance with the features of infectious diseases to analyze and evaluate the economic burden of infectious diseases, technologies and strategies for prevention and treatment monitoring of infectious diseases. Taking chronic hepatitis B as an example, we estimated the economic burden, economic effects of prevention technologies and strategies, and economic impact of the treatment monitoring technologies and strategies. The major innovations in this study are as following:1, Establishment of mathematical models for determination of the optimal strategy for monitoring of the treatment of chronic infectious diseases. Markov decision models were established in this study to optimize strategies for monitoring the drug resistance during treatment of chronic infectious diseases. This will be helpful for effective treatment of infectious diseases and reduce of the health care costs.2, Establishment of mathematical models for determination of optimal timing for treatment monitoring. Currently, the time of initiation and intervals of treatment monitoring is based on the experiences of clinical physicians. Decision models established in this study may be used for determination of the optimal intervals of monitoring during treatment of chronic infectious diseases.3, Establishment of mathematical models for economic analysis of treatment monitoring of chronic infectious diseases. Treatment monitoring technologies are newly developed technologies based on the pharmacogenomics. A incremental cost-effective analysis model was established in this study for economic evaluation of the monitoring technologies during treatment of chronic infectious diseases.4, Systematic analysis of the economic burden, the economic impacts of prevention and treatment monitoring technologies and strategies of chronic hepatitis B infection in China. China has very great economic burden of hepatitis B infection in the world. However, studies on the economic burden of this disease in China are limited. In this study, based on the newly published data on chronic hepatitis B in China, we systematically estimated the economic burden of chronic hepatitis B in China, analyzed the economic effects of universal immunization programme of hepatitis B vaccine, and evaluated the economic impact of monitoring of treatment of chronic hepatitis B. This will put new insight into the prevention and control of chronic hepatitis B in China.