Muennig P, Pallin D, Challah C, Khan K
Department of Health Policy and Management, Mailman School of Public Health, Columbia University, NY 10032, USA.
Epidemiol Infect. 2004 Dec;132(6):1055-63. doi: 10.1017/s0950268804003000.
The presumptive treatment of parasitosis among immigrants with albendazole has been shown to save both money and lives, primarily via a reduction in the burden of Strongyloides stercoralis. Ivermectin is more effective than albendazole, but is also more expensive. This coupled with confusion surrounding the cost-effectiveness of guiding therapy based on eosinophil counts has led to disparate practices. We used the newly arrived year 2000 immigrant population as a hypothetical cohort in a decision analysis model to examine the cost-effectiveness of various interventions to reduce parasitosis among immigrants. When the prevalence of S. stercoralis is greater than 2%, the incremental cost-effectiveness ratios of all presumptive treatment strategies were similar. Ivermectin is associated with an incremental cost-effectiveness ratio of 1700 dollars per QALY gained for treatment with 12 mg ivermectin relative to 5 days of albendazole when the prevalence is 10%. Any presumptive treatment strategy is cost-effective when compared with most common medical interventions.
已证明，使用阿苯达唑对移民中的寄生虫病进行推定治疗可节省资金并挽救生命，主要是通过减轻粪类圆线虫的负担。伊维菌素比阿苯达唑更有效，但也更昂贵。再加上基于嗜酸性粒细胞计数指导治疗的成本效益存在困惑，导致了不同的做法。我们在决策分析模型中使用2000年新到的移民人口作为假设队列，以检验各种减少移民中寄生虫病干预措施的成本效益。当粪类圆线虫患病率大于2%时，所有推定治疗策略的增量成本效益比相似。当患病率为10%时，相对于5天阿苯达唑治疗，使用12毫克伊维菌素治疗的增量成本效益比为每获得一个质量调整生命年1700美元。与大多数常见医疗干预措施相比，任何推定治疗策略都具有成本效益。
