Griekspoor A, Sondorp E, Vos T
Médecins Sans Frontières, Amsterdam, The Netherlands.
Health Policy Plan. 1999 Mar;14(1):70-6. doi: 10.1093/heapol/14.1.70.
Spending by aid agencies on emergencies has quadrupled over the last decade, to over US$6 billion. To date, cost-effectiveness has seldom been considered in the prioritization and evaluation of emergency interventions. The sheer volume of resources spent on humanitarian aid and the chronicity of many humanitarian interventions call for more attention to be paid to the issue of 'value for money'. In this paper we present data from a major humanitarian crisis, an epidemic of visceral leishmaniasis (VL) in war-torn Sudan. The special circumstances provided us, in retrospect, with unusually accurate data on excess mortality, costs of the intervention and its effects, thus allowing us to express cost-effectiveness as the cost per Disability Adjusted Life Year (DALY) averted. The cost-effectiveness ratio, of US$18.40 per DALY (uncertainty range between US$13.53 and US$27.63), places the treatment of VL in Sudan among health interventions considered 'very good value for money' (interventions of less than US$25 per DALY). We discuss the usefulness of this analysis to the internal management of the VL programme, the procurement of funds for the programme, and more generally, to priority setting in humanitarian relief interventions. We feel that in evaluations of emergency interventions attempts could be made more often to perform cost-effectiveness analyses, including the use of DALYs, provided that the outcomes of these analyses are seen in the broad context of the emergency situation and its consequences on the affected population. This paper provides a first contribution to what is hoped to become an international database of cost-effectiveness studies of health interventions during relief operations, which use a comparable measure of health outcome such as the DALY.
在过去十年中，援助机构在紧急情况上的支出增长了四倍，超过了60亿美元。迄今为止，在紧急干预措施的优先排序和评估中，很少考虑成本效益。投入到人道主义援助的资源数量庞大，且许多人道主义干预措施具有长期性，这就要求人们更多地关注“资金价值”问题。在本文中，我们展示了来自一场重大人道主义危机的数据，即饱受战争蹂躏的苏丹发生的内脏利什曼病（VL）疫情。事后看来，特殊情况为我们提供了关于超额死亡率、干预措施成本及其效果的异常准确的数据，从而使我们能够将成本效益表示为避免每一个伤残调整生命年（DALY）的成本。每DALY的成本效益比为18.40美元（不确定范围在13.53美元至27.63美元之间），这使得苏丹的VL治疗在被认为“性价比非常高”的卫生干预措施（每DALY低于25美元的干预措施）中名列前茅。我们讨论了这种分析对VL项目内部管理、该项目资金采购的有用性，更广泛地说，对人道主义救援干预措施的优先排序的有用性。我们认为，在评估紧急干预措施时，可以更频繁地尝试进行成本效益分析，包括使用DALYs，前提是这些分析的结果要在紧急情况及其对受影响人群的后果的广泛背景下看待。本文为有望成为救援行动期间卫生干预措施成本效益研究国际数据库的工作做出了首次贡献，该数据库使用DALY等可比卫生结果衡量指标。
