Yukich Joshua O, Zerom Mehari, Ghebremeskel Tewolde, Tediosi Fabrizio, Lengeler Christian
Swiss Tropical Institute, P,O, Box, 4002 Basel, Switzerland.
Malar J. 2009 Mar 30;8:51. doi: 10.1186/1475-2875-8-51.
While insecticide-treated nets (ITNs) are a recognized effective method for preventing malaria, there has been an extensive debate in recent years about the best large-scale implementation strategy. Implementation costs and cost-effectiveness are important elements to consider when planning ITN programmes, but so far little information on these aspects is available from national programmes.
This study uses a standardized methodology, as part of a larger comparative study, to collect cost data and cost-effectiveness estimates from a large programme providing ITNs at the community level and ante-natal care facilities in Eritrea. This is a unique model of ITN implementation fully integrated into the public health system.
Base case analysis results indicated that the average annual cost of ITN delivery (2005 USD 3.98) was very attractive when compared with past ITN delivery studies at different scales. Financing was largely from donor sources though the Eritrean government and net users also contributed funding. The intervention's cost-effectiveness was in a highly attractive range for sub-Saharan Africa. The cost per DALY averted was USD 13 - 44. The cost per death averted was USD 438-1449. Distribution of nets coincided with significant increases in coverage and usage of nets nationwide, approaching or exceeding international targets in some areas.
ITNs can be cost-effectively delivered at a large scale in sub-Saharan Africa through a distribution system that is highly integrated into the health system. Operating and sustaining such a system still requires strong donor funding and support as well as a functional and extensive system of health facilities and community health workers already in place.
虽然经杀虫剂处理的蚊帐（ITN）是预防疟疾的一种公认有效方法，但近年来关于最佳大规模实施策略存在广泛争论。在规划ITN项目时，实施成本和成本效益是需要考虑的重要因素，但到目前为止，国家项目中关于这些方面的信息很少。
本研究采用标准化方法，作为一项更大规模比较研究的一部分，从厄立特里亚一个在社区层面和产前护理设施提供ITN的大型项目中收集成本数据和成本效益估计值。这是一个完全融入公共卫生系统的ITN实施独特模式。
基础案例分析结果表明，与过去不同规模的ITN交付研究相比，ITN交付的平均年度成本（2005年为3.98美元）非常有吸引力。资金主要来自捐助方，不过厄立特里亚政府和蚊帐使用者也提供了资金。该干预措施的成本效益在撒哈拉以南非洲处于极具吸引力的范围内。每避免一个伤残调整生命年的成本为13 - 44美元。每避免一例死亡的成本为438 - 1449美元。蚊帐的分发与全国范围内蚊帐覆盖率和使用率的显著提高相吻合，在一些地区接近或超过了国际目标。
通过高度融入卫生系统的分发系统，ITN可以在撒哈拉以南非洲大规模地以具有成本效益的方式交付。运营和维持这样一个系统仍然需要强大的捐助资金和支持，以及一个已经存在的运转良好且广泛的卫生设施和社区卫生工作者系统。
