Muennig P, Pallin D, Sell R L, Chan M S
Refugee Health Program, New York City Department of Health, Columbia University School of Public Health, New York 10013, USA.
N Engl J Med. 1999 Mar 11;340(10):773-9. doi: 10.1056/NEJM199903113401006.
Currently, more than 600,000 immigrants enter the United States each year from countries where intestinal parasites are endemic. At entry persons with parasitic infections may be asymptomatic, and stool examinations are not a sensitive method of screening for parasitosis. Albendazole is a new, broad-spectrum antiparasitic drug, which was approved recently by the Food and Drug Administration. International trials have shown albendazole to be safe and effective in eradicating many parasites. In the United States there is now disagreement about whether to screen all immigrants for parasites, treat all immigrants presumptively, or do nothing unless they have symptoms.
We compared the costs and benefits of no preventive intervention (watchful waiting) with those of universal screening or presumptive treatment with 400 mg of albendazole per day for five days. Those at risk were defined as immigrants to the United States from Asia, the Middle East, sub-Saharan Africa, Eastern Europe, and Latin America and the Caribbean. Cost effectiveness was expressed both in terms of the cost of treatment per disability-adjusted life-year (DALY) averted (one DALY is defined as the loss of one year of healthy life to disease) and in terms of the cost per hospitalization averted.
As compared with watchful waiting, presumptive treatment of all immigrants at risk for parasitosis would avert at least 870 DALYs, prevent at least 33 deaths and 374 hospitalizations, and save at least $4.2 million per year. As compared with watchful waiting, screening would cost $159,236 per DALY averted.
Presumptive administration of albendazole to all immigrants at risk for parasitosis would save lives and money. Universal screening, with treatment of persons with positive stool examinations, would save lives but is less cost effective than presumptive treatment.
目前，每年有超过60万移民从肠道寄生虫流行的国家进入美国。入境时，寄生虫感染患者可能没有症状，而粪便检查并非筛查寄生虫病的敏感方法。阿苯达唑是一种新型广谱抗寄生虫药物，最近已获美国食品药品监督管理局批准。国际试验表明，阿苯达唑在根除多种寄生虫方面安全有效。在美国，目前对于是否对所有移民进行寄生虫筛查、对所有移民进行预防性治疗，还是除非有症状否则不采取任何措施存在分歧。
我们比较了不进行预防性干预（观察等待）与进行普遍筛查或每天服用400毫克阿苯达唑、连服五天进行预防性治疗的成本和效益。高危人群定义为来自亚洲、中东、撒哈拉以南非洲、东欧以及拉丁美洲和加勒比地区的美国移民。成本效益通过避免每一个伤残调整生命年（DALY）（一个DALY定义为因疾病而损失的一年健康生命）的治疗成本以及避免每一次住院的成本来表示。
与观察等待相比，对所有有寄生虫病风险的移民进行预防性治疗每年至少可避免870个DALY，预防至少33例死亡和374次住院，并至少节省420万美元。与观察等待相比，筛查每避免一个DALY的成本为159,236美元。
对所有有寄生虫病风险的移民进行阿苯达唑预防性给药可挽救生命并节省资金。对粪便检查呈阳性者进行治疗的普遍筛查可挽救生命，但成本效益低于预防性治疗。
