Binka F N, Mensah O A, Mills A
Ministry of Health, Navrongo, Ghana.
Health Policy. 1997 Sep;41(3):229-39. doi: 10.1016/s0168-8510(97)00035-3.
Permethrin impregnated bednets are now being widely promoted as an effective means of protecting African children against malaria, but there is little evidence of their cost-effectiveness. The impact on child mortality of introducing permethrin impregnated bednets was evaluated in a rural district of northern Ghana in a controlled trial. The cost-effectiveness of the intervention is reported in this paper. The total cost of the intervention over the 2 years of follow-up was US $148,245. Cost per impregnated bednet per year and per person protected per year was US $2.4 and 1.2, respectively. Approximately 16,800 child years were protected and 74 child deaths averted at an estimated cost of US $8.8 per child year protected and US $2003 per death averted. In this rural community, where life expectancy at the mean age of death of trial children was 57.5 years, the estimated cost per discounted healthy life-year gained was US $73.5. Sensitivity analysis suggested that this cost-effectiveness ratio might be reduced substantially by feasible changes in programme implementation. This study supports the argument that the cost-effectiveness of bednet impregnation is sufficiently attractive to make it part of a package of high priority interventions for children. Issues of how to finance the provision of nets and insecticide, and especially the relative contribution of governments, households and donors, need urgently to be addressed.
氯菊酯浸渍蚊帐目前作为保护非洲儿童免受疟疾侵害的一种有效手段而得到广泛推广，但几乎没有证据表明其具有成本效益。在加纳北部的一个农村地区进行了一项对照试验，评估了引入氯菊酯浸渍蚊帐对儿童死亡率的影响。本文报告了该干预措施的成本效益。在两年的随访期内，干预措施的总成本为148,245美元。每年每顶浸渍蚊帐和每年每位受保护者的成本分别为2.4美元和1.2美元。大约有16,800儿童年得到了保护，避免了74例儿童死亡，估计每保护一个儿童年的成本为8.8美元，每避免一例死亡的成本为2003美元。在这个农村社区，试验儿童平均死亡年龄的预期寿命为57.5岁，每获得一个贴现后的健康生命年的估计成本为73.5美元。敏感性分析表明，通过对项目实施进行可行的调整，这一成本效益比可能会大幅降低。这项研究支持了这样一种观点，即蚊帐浸渍的成本效益具有足够的吸引力，使其成为儿童高优先级干预措施组合的一部分。如何为蚊帐和杀虫剂的供应筹集资金，特别是政府、家庭和捐助者的相对贡献等问题，亟待解决。
