Shrestha Ram K, Marseille Elliot, Kahn James G, Lule John R, Pitter Christian, Blandford John M, Bunnell Rebecca, Coutinho Alex, Kizito Francis, Quick Robert, Mermin Jonathan
Global AIDS Program, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 20333, USA.
Am J Trop Med Hyg. 2006 May;74(5):884-90.
Safe water systems (SWSs) have been shown to reduce diarrhea and death. We examined the cost-effectiveness of SWS for HIV-affected households using health outcomes and costs from a randomized controlled trial in Tororo, Uganda. SWS was part of a home-based health care package that included rapid diarrhea diagnosis and treatment of 196 households with relatively good water and sanitation coverage. SWS use averted 37 diarrhea episodes and 310 diarrhea-days, representing 0.155 disability-adjusted life year (DALY) gained per 100 person-years, but did not alter mortality. Net program costs were 5.21 dollars/episode averted, 0.62 dollars/diarrhea-day averted, and 1,252 dollars/DALY gained. If mortality reduction had equaled another SWS trial in Kenya, the cost would have been 11 dollars/DALY gained. The high SWS cost per DALY gained was probably caused by a lack of mortality benefit in a trial designed to rapidly treat diarrhea. SWS is an effective intervention whose cost-effectiveness is sensitive to diarrhea-related mortality, diarrhea incidence, and effective clinical management.
安全饮水系统（SWSs）已被证明可减少腹泻和死亡。我们利用乌干达托罗罗一项随机对照试验的健康结果和成本，研究了SWS对受艾滋病影响家庭的成本效益。SWS是一项居家医疗保健套餐的一部分，该套餐包括对196户水和卫生设施覆盖率相对较好的家庭进行快速腹泻诊断和治疗。使用SWS避免了37次腹泻发作和310个腹泻日，相当于每100人年获得0.155个伤残调整生命年（DALY），但未改变死亡率。项目净成本为每避免一次腹泻发作5.21美元，每避免一个腹泻日0.62美元，每获得一个DALY 1252美元。如果死亡率降低程度与肯尼亚另一项SWS试验相同，那么每获得一个DALY的成本将为11美元。每获得一个DALY的SWS成本较高，可能是因为在一项旨在快速治疗腹泻的试验中缺乏降低死亡率的益处。SWS是一种有效的干预措施，其成本效益对腹泻相关死亡率、腹泻发病率和有效的临床管理较为敏感。
