Hogan Daniel R, Baltussen Rob, Hayashi Chika, Lauer Jeremy A, Salomon Joshua A
Harvard Center for Population and Development Studies, Harvard School of Public Health, Cambridge, MA 02138, USA.
BMJ. 2005 Dec 17;331(7530):1431-7. doi: 10.1136/bmj.38643.368692.68. Epub 2005 Nov 10.
OBJECTIVE: To assess the costs and health effects of a range of interventions for preventing the spread of HIV and for treating people with HIV/AIDS in the context of the millennium development goal for combating HIV/AIDS. DESIGN: Cost effectiveness analysis based on an epidemiological model. SETTING: Analyses undertaken for two regions classified using the WHO epidemiological grouping-Afr-E, countries in sub-Saharan Africa with very high adult and high child mortality, and Sear-D, countries in South East Asia with high adult and high child mortality. DATA SOURCES: Biological and behavioural parameters from clinical and observational studies and population based surveys. Intervention effects and resource inputs based on published reports, expert opinion, and the WHO-CHOICE database. MAIN OUTCOME MEASURES: Costs per disability adjusted life year (DALY) averted in 2000 international dollars (Int dollars). RESULTS: In both regions interventions focused on mass media, education and treatment of sexually transmitted infections for female sex workers, and treatment of sexually transmitted infections in the general population cost < Int150 dollars per DALY averted. Voluntary counselling and testing costs < Int350 dollars per DALY averted in both regions, while prevention of mother to child transmission costs < Int50 dollars per DALY averted in Afr-E but around Int850 dollars per DALY in Sear-D. School based education strategies and various antiretroviral treatment strategies cost between Int500 dollars and Int5000 dollars per DALY averted. CONCLUSIONS: Reducing HIV transmission could be done most efficiently through mass media campaigns, interventions for sex workers and treatment of sexually transmitted infections where resources are most scarce. However, prevention of mother to child transmission, voluntary counselling and testing, and school based education would yield further health gains at higher budget levels and would be regarded as cost effective or highly cost effective based on standard international benchmarks. Antiretroviral therapy is at least as cost effective in improving population health as some of these interventions.
目的：在防治艾滋病毒/艾滋病千年发展目标的背景下，评估一系列预防艾滋病毒传播及治疗艾滋病毒/艾滋病患者的干预措施的成本和健康影响。 设计：基于流行病学模型的成本效益分析。 背景：针对根据世界卫生组织流行病学分组分类的两个地区进行分析——Afr-E，撒哈拉以南非洲地区，成人和儿童死亡率极高的国家；以及Sear-D，东南亚地区，成人和儿童死亡率高的国家。 数据来源：来自临床和观察性研究以及基于人群的调查的生物学和行为学参数。基于已发表报告、专家意见和世界卫生组织-CHOICE数据库的干预效果和资源投入。 主要结局指标：以2000年国际美元（Int美元）计算的每避免一个伤残调整生命年（DALY）的成本。 结果：在这两个地区，针对女性性工作者的大众媒体、教育和性传播感染治疗以及普通人群中性传播感染治疗的干预措施，每避免一个DALY的成本均低于150 Int美元。在这两个地区，自愿咨询和检测每避免一个DALY的成本低于350 Int美元，而预防母婴传播在Afr-E地区每避免一个DALY的成本低于50 Int美元，但在Sear-D地区约为每DALY 850 Int美元。基于学校的教育策略和各种抗逆转录病毒治疗策略每避免一个DALY的成本在500 Int美元至5000 Int美元之间。 结论：在资源最为稀缺的情况下，通过大众媒体宣传活动、针对性工作者的干预措施和性传播感染治疗，可以最有效地减少艾滋病毒传播。然而，预防母婴传播、自愿咨询和检测以及基于学校的教育在更高预算水平下将带来进一步的健康收益，并且根据标准国际基准将被视为具有成本效益或极具成本效益。抗逆转录病毒疗法在改善人群健康方面至少与其中一些干预措施一样具有成本效益。
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