Collinet-Adler Stefan, Stauffer William M, Boulware David R, Larsen Kevin L, Rogers Tyson B, Williams David N
Hennepin County Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Am J Trop Med Hyg. 2007 Sep;77(3):458-63.
This study is a cost-benefits analysis of the recommendations of the Centers for Disease Control and Prevention for presumptive anti-malarial treatment among departing West African refugees. We conducted a retrospective chart review of symptomatic, blood smear-positive cases of malaria seen in Minneapolis, Minnesota, from 1996 through 2005. Billing charges of U.S. care were compared with estimates of implementation costs for overseas treatment. Fifty-eight symptomatic malaria infections occurred among West African refugees. After overseas pre-departure presumptive treatment, symptomatic malaria in arriving refugees decreased from 8.2% to 0%. The pre-departure number needed to treat to prevent one case of symptomatic malaria is 13.9 (95% confidence interval = 9.8-24). The average U.S. billing charge for each malaria case is $1,730. Overseas implementation costs for presumptive treatment are estimated to be between $141 and $346 to prevent one U.S. malaria case. Overseas presumptive pre-departure anti-malarial therapy prevents clinical malaria in refugees and results in cost-benefits when the malaria prevalence is > 1%. Overseas presumptive therapy has greater cost-benefits than U.S. based screening and treatment strategies.
本研究是对疾病控制与预防中心关于对即将离境的西非难民进行推定抗疟治疗建议的成本效益分析。我们对1996年至2005年期间在明尼苏达州明尼阿波利斯市出现症状且血涂片呈阳性的疟疾病例进行了回顾性病历审查。将美国的医疗计费费用与海外治疗的实施成本估计进行了比较。在西非难民中发生了58例有症状的疟疾感染。在进行海外离境前推定治疗后，抵达的难民中有症状疟疾的发生率从8.2%降至0%。预防一例有症状疟疾所需的离境前治疗人数为13.9（95%置信区间=9.8 - 24）。每例疟疾病例的美国平均计费费用为1730美元。推定治疗的海外实施成本估计为预防一例美国疟疾病例141美元至346美元。当疟疾流行率>1%时，海外离境前推定抗疟治疗可预防难民中的临床疟疾并产生成本效益。海外推定治疗比基于美国的筛查和治疗策略具有更大的成本效益。
