Veterinary Clinical Sciences, Royal Veterinary College, North Mymms, Hatfield, United Kingdom.
Prev Vet Med. 2012 Feb 1;103(2-3):93-111. doi: 10.1016/j.prevetmed.2011.09.013. Epub 2011 Oct 20.
Empirical analyses founded on sound economic principles are essential in advising policy makers on the efficiency of resource use for disease mitigation. Surveillance and intervention are resource-using activities directed at mitigation. Surveillance helps to offset negative disease effects by promoting successful intervention. Intervention is the process of implementing measures (e.g. vaccination or medication) to reduce or remove a hazard in a population. The scale and ratios in which the two are combined affect the efficiency of mitigation, its costs, benefits, and thus net effect on society's well-being. The Swiss national mitigation programme for bluetongue virus serotype 8 was used as case study to investigate the economic efficiency of mitigation. In 2008, Switzerland implemented a vaccination programme to avoid and reduce disease and infection in its ruminant population. To monitor the vaccination programme and the vector dynamics, a surveillance system consisting of serological and entomological surveillance was established. Retrospective analyses for the years 2008-2009 and prospective analyses for the years 2010-2012 were conducted to investigate if the mitigation programme was economically beneficial. In the retrospective analysis, the implemented programme (=comparative scenario) was compared to a hypothesised baseline scenario of voluntary vaccination and surveillance. In the prospective analysis, the comparative scenario assumed to continue was compared to two baseline scenarios: one of voluntary vaccination combined with surveillance and one of no vaccination combined with surveillance. For each scenario, monetary surveillance, intervention and disease costs were calculated. The comparison of baseline and comparative scenarios yielded estimates for the total benefit (=disease costs avoided), margin over intervention cost and the net value of the programme. For 2008-2009, in aggregate, the mean biannual total benefit was 17.46 m Swiss francs (CHF) (1CHF=0.66€ at the time of analysis) and the mean net benefit after subtraction of the intervention and surveillance cost was 3.95 m CHF. For the three years 2010-2012, overall net costs were estimated at 12.93 m and 8.11 m CHF, respectively, for comparison of the implemented mitigation programme with the two baseline scenarios. It was concluded that the surveillance and intervention programme implemented in 2008-2009 was economically beneficial, while its continuation in the same form in 2010-2012 would produce net costs. These costs were due to the mean intervention cost remaining constant at a level of approximately 11 m CHF per year while the mean total benefit would be gradually reduced in 2010-2012 due to the reduced occurrence of disease in a fully vaccinated population.
基于可靠经济原则的实证分析对于就疾病缓解过程中资源使用效率为政策制定者提供建议至关重要。监测和干预是针对缓解的资源利用活动。监测通过促进成功干预来抵消疾病的负面影响。干预是指实施措施（例如接种疫苗或药物）以减少或消除人群中的危害的过程。这两者结合的规模和比例会影响缓解的效率、成本、收益，进而影响社会福祉的净效应。使用瑞士国家针对蓝舌病 8 型的缓解计划作为案例研究，以调查缓解的经济效益。2008 年，瑞士实施了一项疫苗接种计划，以避免和减少反刍动物种群中的疾病和感染。为了监测疫苗接种计划和媒介动态，建立了一个由血清学和昆虫学监测组成的监测系统。对 2008-2009 年进行了回顾性分析，并对 2010-2012 年进行了前瞻性分析，以调查缓解计划是否具有经济效益。在回顾性分析中，实施的计划（=比较方案）与自愿接种和监测的假设基线方案进行了比较。在前瞻性分析中，假设继续实施的比较方案与两个基线方案进行了比较：一个是自愿接种和监测相结合的方案，另一个是不接种和监测相结合的方案。对于每个方案，都计算了监测、干预和疾病成本。基线和比较方案的比较得出了总收益（=避免的疾病成本）、干预成本超额和方案净值的估计值。对于 2008-2009 年，总的两年半平均总收益为 1746 万瑞士法郎（CHF）（分析时 1CHF=0.66€），减去干预和监测成本后的平均净收益为 395 万 CHF。对于 2010-2012 年的三年，实施的缓解计划与两个基线方案进行比较的总成本分别估计为 1293 万和 811 万 CHF。结论是，2008-2009 年实施的监测和干预计划具有经济效益，而在 2010-2012 年以相同形式继续实施该计划将产生净成本。这些成本是由于干预成本保持在每年约 1100 万 CHF 的水平不变，而在 2010-2012 年，由于完全接种疫苗的人群中疾病发生减少，平均总收益将逐渐减少。
