孟加拉国社区卫生工作者在结核病控制中的成本效益
Cost-effectiveness of community health workers in tuberculosis control in Bangladesh.
作者信息
Islam Md Akramul, Wakai Susumu, Ishikawa Nobukatsu, Chowdhury A M R, Vaughan J Patrick
机构信息
Bangladesh Rural Advancement Committee, Dhaka, Bangladesh.
出版信息
Bull World Health Organ. 2002;80(6):445-50.
OBJECTIVE
To compare the cost-effectiveness of the tuberculosis (TB) programme run by the Bangladesh Rural Advancement Committee (BRAC), which uses community health workers (CHWs), with that of the government TB programme which does not use CHWs.
METHODS
TB control statistics and cost data for July 1996 - June 1997 were collected from both government and BRAC thanas (subdistricts) in rural Bangladesh. To measure the cost per patient cured, total costs were divided by the total number of patients cured.
FINDINGS
In the BRAC and government areas, respectively, a total of 186 and 185 TB patients were identified over one year, with cure rates among sputum-positive patients of 84% and 82%. However, the cost per patient cured was US$ 64 in the BRAC area compared to US$ 96 in the government area.
CONCLUSION
The government programme was 50% more expensive for similar outcomes. Although both the BRAC and government TB control programmes appeared to achieve satisfactory cure rates using DOTS (a five-point strategy), the involvement of CHWs was found to be more cost-effective in rural Bangladesh. With the same budget, the BRAC programme could cure three TB patients for every two in the government programme.
目的
比较由孟加拉国农村发展委员会（BRAC）开展的结核病防治项目（该项目使用社区卫生工作者）与不使用社区卫生工作者的政府结核病防治项目的成本效益。
方法
从孟加拉国农村的政府和BRAC乡（分区）收集了1996年7月至1997年6月的结核病控制统计数据和成本数据。为了计算每治愈一名患者的成本，将总成本除以治愈患者的总数。
研究结果
在BRAC地区和政府地区，一年中分别共识别出186例和185例结核病患者，痰涂片阳性患者的治愈率分别为84%和82%。然而，BRAC地区每治愈一名患者的成本为64美元，而政府地区为96美元。
结论
在取得相似结果的情况下，政府项目的成本高出50%。尽管BRAC和政府的结核病控制项目似乎都通过直接观察短程治疗（一种五点策略）实现了令人满意的治愈率，但研究发现，在孟加拉国农村，社区卫生工作者的参与更具成本效益。在相同预算下，BRAC项目每治愈三名结核病患者，政府项目只能治愈两名。
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