Roth Felix, Zinsstag Jakob, Orkhon Dontor, Chimed-Ochir G, Hutton Guy, Cosivi Ottorino, Carrin Guy, Otte Joachim
Swiss Centre for International Health, Swiss Tropical Institute, Basle, Switzerland.
Bull World Health Organ. 2003;81(12):867-76. Epub 2004 Mar 1.
To estimate the economic benefit, cost-effectiveness, and distribution of benefit of improving human health in Mongolia through the control of brucellosis by mass vaccination of livestock.
Cost-effectiveness and economic benefit for human society and the agricultural sector of mass vaccination against brucellosis was modelled. The intervention consisted of a planned 10-year livestock mass vaccination campaign using Rev-1 livestock vaccine for small ruminants and S19 livestock vaccine for cattle. Cost-effectiveness, expressed as cost per disability-adjusted life year (DALY) averted, was the primary outcome.
In a scenario of 52% reduction of brucellosis transmission between animals achieved by mass vaccination, a total of 49,027 DALYs could be averted. Estimated intervention costs were US$ 8.3 million, and the overall benefit was US$ 26.6 million. This results in a net present value of US$ 18.3 million and an average benefit-cost ratio for society of 3.2 (2.27-4.37). If the costs of the intervention were shared between the sectors in proportion to the benefit to each, the public health sector would contribute 11%, which gives a cost-effectiveness of US$ 19.1 per DALY averted (95% confidence interval 5.3-486.8). If private economic gain because of improved human health was included, the health sector should contribute 42% to the intervention costs and the cost-effectiveness would decrease to US$ 71.4 per DALY averted.
If the costs of vaccination of livestock against brucellosis were allocated to all sectors in proportion to the benefits, the intervention might be profitable and cost effective for the agricultural and health sectors.
评估通过对牲畜进行大规模疫苗接种来控制布鲁氏菌病，从而改善蒙古民众健康状况所带来的经济效益、成本效益及效益分配情况。
对针对布鲁氏菌病进行大规模疫苗接种给人类社会和农业部门带来的成本效益及经济效益进行建模。干预措施包括计划开展为期10年的牲畜大规模疫苗接种活动，对小反刍动物使用Rev-1牲畜疫苗，对牛使用S19牲畜疫苗。以避免的每伤残调整生命年（DALY）成本来表示的成本效益是主要结果。
在大规模疫苗接种使动物间布鲁氏菌病传播减少52%的情况下，总共可避免49,027个DALY。估计干预成本为830万美元，总效益为2660万美元。这导致净现值为1830万美元，社会的平均效益成本比为3.2（2.27 - 4.37）。如果干预成本按各部门所获效益的比例分摊，公共卫生部门将承担11%，这使得避免每个DALY的成本效益为19.1美元（95%置信区间5.3 - 486.8）。如果将因人类健康改善带来的私人经济收益纳入，卫生部门应承担42%的干预成本，成本效益将降至每个DALY避免成本71.4美元。
如果按效益比例将牲畜布鲁氏菌病疫苗接种成本分摊到所有部门，该干预措施对农业和卫生部门而言可能既盈利又具有成本效益。
