Ettling M B, Shepard D S
Department of Population Sciences, Harvard School of Public Health, Boston, Massachusetts.
Trop Med Parasitol. 1991 Sep;42(3):214-8.
Although malaria is widely recognized as a major public health problem in much of Africa, its impact on a specific national or regional economy has proved difficult to assess. This paper demonstrates the kind of analysis possible given available national aggregate statistics on epidemiology and economic indicators, the type of data most readily available. An economic model which applies the average cost of malaria per case to the known number of cases in Rwanda for 1989 estimated the total cost to be $ 2.88 per capita (in 1987 US dollars). Of this cost, $0.63 per capita represents the direct cost of treatment, including care of outpatients and hospitalized cases in both government and private facilities, as well as self-treatment. The other $ 2.25 per capita represents the indirect costs of productive time lost to malaria morbidity in adults and to care for sick children, and the cost of lifetime earnings lost through premature malaria mortality. The average output per day of the Rwandan economy was $0.83 in 1989. Thus, the per capita malaria cost equals 3.5 days of production or 1% of GDP. The average cost of each of the 1,722,271 reported malaria cases in 1989 was $11.82: $2.58 in direct and $9.24 in indirect cost. The direct cost per case is equal to 160% of the per capita budget of the Ministry of Health. Economic and epidemiological projections to 1995 yield an increase in malaria cases to over 4 million at a cost of $7.11 per capita. Direct costs are projected to rise over 200% due to increasing costs of drugs and supplies to treat increasingly drug-resistant cases. Indirect costs, which are tied to a declining economy, are projected to rise by just over 100%. By 1995, malaria is projected to cost 2.4% of the Rwandan GDP, exacerbating an already serious impact.
尽管疟疾在非洲大部分地区被广泛认为是一个主要的公共卫生问题，但其对特定国家或地区经济的影响却难以评估。本文展示了利用现有的关于流行病学和经济指标的国家综合统计数据（最容易获取的数据类型）所能进行的分析类型。一个经济模型将卢旺达1989年已知疟疾病例数乘以每例疟疾的平均成本，估计总成本为人均2.88美元（按1987年美元计算）。在这笔成本中，人均0.63美元代表治疗的直接成本，包括政府和私立医疗机构中门诊病人和住院病人的护理以及自我治疗的费用。另外人均2.25美元代表因成年人患疟疾导致生产时间损失以及照顾患病儿童的间接成本，以及因疟疾过早死亡导致的终身收入损失成本。1989年卢旺达经济的日均产出为0.83美元。因此，人均疟疾成本相当于3.5天的产出或国内生产总值的1%。1989年报告的1,722,271例疟疾病例中，每例的平均成本为11.82美元：直接成本2.58美元，间接成本9.24美元。每例的直接成本相当于卫生部人均预算的160%。到1995年的经济和流行病学预测显示，疟疾病例将增加到4百余万，人均成本为7.11美元。由于治疗耐药性不断增加的病例所需药品和物资成本上升，预计直接成本将增长超过200%。与经济衰退相关的间接成本预计将增长略超过100%。到1995年，预计疟疾将耗费卢旺达国内生产总值的2.4%，加剧业已严重的影响。
