Njau Joseph D, Goodman Catherine A, Kachur S Patrick, Mulligan Jo, Munkondya John S, McHomvu Naiman, Abdulla Salim, Bloland Peter, Mills Anne
Ifakara Health Research & Development Centre, PO Box 78373, Dar es Salaam, Tanzania.
Malar J. 2008 Jan 7;7:4. doi: 10.1186/1475-2875-7-4.
The development of antimalarial drug resistance has led to increasing calls for the introduction of artemisinin-based combination therapy (ACT). However, little evidence is available on the full costs associated with changing national malaria treatment policy. This paper presents findings on the actual drug and non-drug costs associated with deploying ACT in one district in Tanzania, and uses these data to estimate the nationwide costs of implementation in a setting where identification of malaria cases is primarily dependant on clinical diagnosis.
Detailed data were collected over a three year period on the financial costs of providing ACT in Rufiji District as part of a large scale effectiveness evaluation, including costs of drugs, distribution, training, treatment guidelines and other information, education and communication (IEC) materials and publicity. The district-level costs were scaled up to estimate the costs of nationwide implementation, using four scenarios to extrapolate variable costs.
The total district costs of implementing ACT over the three year period were slightly over one million USD, with drug purchases accounting for 72.8% of this total. The composite (best) estimate of nationwide costs for the first three years of ACT implementation was 48.3 million USD (1.29 USD per capita), which varied between 21 and 67.1 million USD in the sensitivity analysis (2003 USD). In all estimates drug costs constituted the majority of total costs. However, non-drug costs such as IEC materials, drug distribution, communication, and health worker training were also substantial, accounting for 31.4% of overall ACT implementation costs in the best estimate scenario. Annual implementation costs are equivalent to 9.5% of Tanzania's recurrent health sector budget, and 28.7% of annual expenditure on medical supplies, implying a 6-fold increase in the national budget for malaria treatment.
The costs of implementing ACT are substantial. Although drug purchases constituted a majority of total costs, non-drug costs were also considerable. It is clear that substantial external resources will be required to facilitate and sustain effective ACT delivery across Tanzania and other malaria-endemic countries.
抗疟药物耐药性的发展导致越来越多的人呼吁引入以青蒿素为基础的联合疗法（ACT）。然而，关于改变国家疟疾治疗政策的全部成本的证据很少。本文介绍了在坦桑尼亚一个地区部署ACT相关的实际药物和非药物成本的研究结果，并利用这些数据估算在疟疾病例识别主要依赖临床诊断的情况下全国范围内的实施成本。
在三年期间收集了关于在鲁菲吉区提供ACT的财务成本的详细数据，作为大规模有效性评估的一部分，包括药物成本、分发成本、培训成本、治疗指南以及其他信息、教育和宣传（IEC）材料及宣传成本。利用四种情景推断可变成本，将地区层面的成本进行扩大推算，以估算全国范围的实施成本。
在三年期间实施ACT的地区总成本略超过100万美元，其中药品采购占总成本的72.8%。ACT实施头三年全国成本的综合（最佳）估计为4830万美元（人均1.29美元），在敏感性分析中（2003年美元），成本在2100万至6710万美元之间变化。在所有估计中，药品成本占总成本的大部分。然而，诸如IEC材料、药品分发、宣传和卫生工作者培训等非药物成本也相当可观，在最佳估计情景中占ACT总体实施成本的31.4%。年度实施成本相当于坦桑尼亚卫生部门经常性预算的9.5%，以及医疗用品年度支出的28.7%，这意味着国家疟疾治疗预算增加了6倍。
实施ACT的成本很高。虽然药品采购占总成本的大部分，但非药物成本也相当可观。显然，需要大量外部资源来促进和维持在坦桑尼亚及其他疟疾流行国家有效提供ACT。
