University of Zürich Centre for Travel Medicine, WHO Collaborating Centre for Travellers' Health, Hirschengraben 84, 8001 Zürich, Switzerland.
BMC Infect Dis. 2010 Sep 22;10:279. doi: 10.1186/1471-2334-10-279.
The importation of malaria to non-endemic countries remains a major cause of travel-related morbidity and a leading cause of travel-related hospitalizations. Currently they are three priority medications for malaria prophylaxis to West Africa: mefloquine, atovaquone/proguanil and doxycycline. We investigate the cost effectiveness of a partial reimbursement of the cheapest effective malaria chemoprophylaxis (mefloquine) for travellers to high risk areas of malaria transmission compared with the current situation of no reimbursement.
This study is a cost-effectiveness analysis based on malaria cases imported from West Africa to Switzerland from the perspective of the Swiss health system. We used a decision tree model and made a literature research on the components of travel related malaria. The main outcome measure was the cost effectiveness of malaria chemoprophylaxis reimbursement based on malaria and deaths averted.
Using a program where travellers would be reimbursed for 80% of the cost of the cheapest malaria chemoprophylaxis is dominant (i.e. cost saving and more effective than the current situation) using the assumption that currently 68.7% of travellers to West Africa use malaria chemoprophylaxis. If the current usage of malaria chemoprophylaxis would be higher, 82.4%, the incremental cost per malaria case averted is € 2'302. The incremental cost of malaria death averted is € 191'833.The most important factors influencing the model were: the proportion of travellers using malaria chemoprophylaxis, the probability of contracting malaria without malaria chemoprophylaxis, the cost of the mefloquine regimen, the decrease in the number of travellers without malaria chemoprophylaxis in the reimbursement strategy.
This study suggests that a reimbursement of 80% of the cost of the cheapest effective malaria chemoprophylaxis (mefloquine) for travellers from Switzerland to West Africa is highly effective in terms of malaria cases averted and is cost effective to the Swiss health system. These data are relevant to discussions about the cost effectiveness of malaria chemoprophylaxis reimbursement for vulnerable groups such as those visiting friends and relatives who have the highest risk of malaria, who are least likely to use chemoprophylaxis.
将疟疾输入非流行地区仍然是导致与旅行相关的发病率的主要原因，也是导致与旅行相关的住院治疗的主要原因。目前，针对西非有三种疟疾预防的重点药物：甲氟喹、阿托伐醌/磺胺多辛和强力霉素。我们调查了对前往疟疾传播高风险地区的旅行者部分报销最便宜有效的抗疟化学预防药物（甲氟喹）的成本效益，与目前不报销的情况相比。
本研究是基于从瑞士卫生系统的角度对从西非输入瑞士的疟疾病例进行的成本效益分析。我们使用决策树模型，并对与旅行相关的疟疾的各个组成部分进行了文献研究。主要结果衡量标准是基于疟疾和避免死亡的抗疟化学预防药物报销的成本效益。
假设目前 68.7%前往西非的旅行者使用抗疟化学预防药物，使用旅行者可报销最便宜的抗疟化学预防药物 80%费用的方案是占主导地位的（即节省成本，比目前的情况更有效）。如果目前抗疟化学预防药物的使用量更高，为 82.4%，则每例疟疾避免发生的增量成本为 2302 欧元。避免疟疾死亡的增量成本为 191833 欧元。影响模型的最重要因素是：使用抗疟化学预防药物的旅行者比例、未使用抗疟化学预防药物感染疟疾的概率、甲氟喹方案的成本、报销策略中未使用抗疟化学预防药物的旅行者数量减少。
本研究表明，对瑞士前往西非的旅行者报销最便宜有效抗疟化学预防药物（甲氟喹）费用的 80%，在避免疟疾病例方面非常有效，并且对瑞士卫生系统具有成本效益。这些数据与讨论针对弱势群体（如探访朋友和亲戚的人）的抗疟化学预防药物报销的成本效益相关，这些人感染疟疾的风险最高，最不可能使用化学预防药物。
