Fisman David N, Lipsitch Marc, Hook Edward W, Goldie Sue J
City of Hamilton Social and Public Health Services Department, McMaster University, Hamilton, Ontario, Canada.
Sex Transm Dis. 2002 Oct;29(10):608-22. doi: 10.1097/00007435-200210000-00008.
Infection with herpes simplex virus type 2 (HSV-2) currently affects approximately 22% of adult Americans and increased markedly in prevalence between the late 1970s and early 1990s. Although some estimates of the costs of prevalent disease due to HSV-2 are available, selection of interventions to prevent HSV-2 infection, as well as evaluation of their potential cost-effectiveness, should take into account projected future costs that will result if the epidemic is left unchecked.
The goal was to estimate the future health and economic consequences attributable to the HSV-2 epidemic in the absence of interventions to slow the epidemic.
A mathematical model was constructed to project future increases in HSV-2 seroprevalence in the United States. The probability of heterosexual transmission of HSV-2 was estimated from cross-sectional estimates of infection prevalence reported by the National Health and Nutrition Examination Survey (NHANES). Per-infection expected costs were calculated on the basis of data obtained from the published medical literature. RESULTS Without intervention, the prevalence of HSV-2 infection among individuals aged 15 to 39 years was projected to increase to 39% among men and 49% among women by 2025. Annual incidence was projected to increase steadily between 2000 and 2025, from 9 to 26 infections per 1,000 men and from 12 to 32 infections per 1,000 women in this age group. The cost of incident infections in the year 2000 were estimated to be $1.8 billion; the cost of incident infections was predicted to rise to $2.5 billion by 2015 and $2.7 billion by 2025. The projected cumulative cost of incident HSV-2 infections occurring over the next 25 years was estimated to be $61 billion; at a 3% discount rate, this sum has a present value of $43 billion.
The costs of incident HSV-2 infection in the United States are substantial and can be expected to increase as both the incidence and prevalence of this disease increase in the first half of the century. The level of resource allocation for HSV-2 prevention strategies should reflect the economic benefits that would result from control of this epidemic.
目前，2型单纯疱疹病毒（HSV-2）感染影响着约22%的美国成年人，其患病率在20世纪70年代末至90年代初显著上升。尽管已有一些关于HSV-2所致流行疾病成本的估算，但在选择预防HSV-2感染的干预措施及其潜在成本效益评估时，应考虑到如果疫情得不到控制将会产生的未来预计成本。
目标是估计在没有采取减缓疫情的干预措施的情况下，HSV-2疫情未来对健康和经济的影响。
构建了一个数学模型来预测美国HSV-2血清阳性率未来的增长情况。HSV-2异性传播概率是根据美国国家健康与营养检查调查（NHANES）报告的感染患病率横断面估计值估算得出的。基于从已发表医学文献中获取的数据计算每次感染的预期成本。结果：若不进行干预，预计到2025年，15至39岁人群中HSV-2感染的患病率男性将增至39%，女性将增至49%。预计2000年至2025年期间年发病率将稳步上升，该年龄组每1000名男性的年发病率将从9例增至26例，每1000名女性将从12例增至32例。2000年新发感染的成本估计为18亿美元；预计到2015年新发感染成本将升至25亿美元，到2025年将达到27亿美元。预计未来25年HSV-2新发感染的累计成本估计为610亿美元；按3%的贴现率计算，这笔金额的现值为430亿美元。
美国HSV-2新发感染的成本巨大，且随着本世纪上半叶该疾病发病率和患病率的上升，预计成本还会增加。HSV-2预防策略的资源分配水平应反映控制该疫情所带来的经济效益。
