Sauerborn R, Shepard D S, Ettling M B, Brinkmann U, Nougtara A, Diesfeld H J
Department of Population Sciences and International Health, Harvard School of Public Health, Boston, Massachusetts.
Trop Med Parasitol. 1991 Sep;42(3):219-23.
Comprehensive estimates of the direct economic costs of malaria should include not only the costs of care at established health facilities, but also other expenditures, such as travel and out-of-pocket costs of drugs. They should include all episodes of illness, whether or not the patient attended a health facility. Also, the indirect economic costs, which are based on the value of time lost due to illness, consider seasonal variations in the marginal product of labor according to the agricultural season. A 1985 representative survey of 626 households in Solenzo medical district, Burkina Faso, provided household data on health service utilization, expenditures, and agricultural production with which to implement these refinements. Numbers of malaria deaths and cases were estimated by adjusting survey totals according to monthly patterns of reported malaria deaths. The marginal product of labor was valued according to typical activities in each of three agricultural seasons: brewing millet beer during the maintenance period (January-February), growing cotton during the cash crop season (March-April), and growing millet and sorghum during the food crop season (May-December). The resulting values were $0.28, $1.09, and $0.55 per day, respectively. Cost per case averaged $5.96 and cost per capita $1.15. Indirect cost due to mortality was the largest cost component ($0.79 per capita), followed by direct costs incurred by the user (e.g. transportation costs and drug purchases, $0.22 per capita). Direct costs paid by providers were small, only $0.04 per capita. A household survey provides the necessary data for more comprehensive population-based estimates of costs of malaria.
疟疾直接经济成本的综合估算不仅应包括在现有医疗机构的治疗成本，还应包括其他支出，如交通费用和药品自付费用。这些估算应涵盖所有发病情况，无论患者是否前往医疗机构就诊。此外，间接经济成本基于因病损失的时间价值，并根据农业季节考虑劳动力边际产品的季节性变化。1985年在布基纳法索索伦佐医疗区对626户家庭进行的代表性调查提供了关于医疗服务利用、支出和农业生产的家庭数据，用以进行这些细化估算。通过根据报告的疟疾死亡月度模式调整调查总数来估算疟疾死亡和病例数。根据三个农业季节各自的典型活动来评估劳动力的边际产品价值：在维护期（1月至2月）酿造小米啤酒、在经济作物季节（3月至4月）种植棉花、在粮食作物季节（5月至12月）种植小米和高粱。由此得出的价值分别为每天0.28美元、1.09美元和0.55美元。每例病例的平均成本为5.96美元，人均成本为1.15美元。因死亡造成的间接成本是最大的成本组成部分（人均0.79美元），其次是使用者产生的直接成本（如交通费用和药品购买，人均0.22美元）。提供者支付的直接成本很小，仅人均0.04美元。家庭调查为基于更全面人群的疟疾成本估算提供了必要数据。
