Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, California, United States of America.
PLoS One. 2012;7(2):e31316. doi: 10.1371/journal.pone.0031316. Epub 2012 Feb 8.
Efficiently delivered interventions to reduce HIV, malaria, and diarrhea are essential to accelerating global health efforts. A 2008 community integrated prevention campaign in Western Province, Kenya, reached 47,000 individuals over 7 days, providing HIV testing and counseling, water filters, insecticide-treated bed nets, condoms, and for HIV-infected individuals cotrimoxazole prophylaxis and referral for ongoing care. We modeled the potential cost-effectiveness of a scaled-up integrated prevention campaign.
We estimated averted deaths and disability-adjusted life years (DALYs) based on published data on baseline mortality and morbidity and on the protective effect of interventions, including antiretroviral therapy. We incorporate a previously estimated scaled-up campaign cost. We used published costs of medical care to estimate savings from averted illness (for all three diseases) and the added costs of initiating treatment earlier in the course of HIV disease.
Per 1000 participants, projected reductions in cases of diarrhea, malaria, and HIV infection avert an estimated 16.3 deaths, 359 DALYs and $85,113 in medical care costs. Earlier care for HIV-infected persons adds an estimated 82 DALYs averted (to a total of 442), at a cost of $37,097 (reducing total averted costs to $48,015). Accounting for the estimated campaign cost of $32,000, the campaign saves an estimated $16,015 per 1000 participants. In multivariate sensitivity analyses, 83% of simulations result in net savings, and 93% in a cost per DALY averted of less than $20.
A mass, rapidly implemented campaign for HIV testing, safe water, and malaria control appears economically attractive.
高效实施的干预措施，以减少艾滋病毒、疟疾和腹泻，对于加速全球卫生工作至关重要。2008 年在肯尼亚西部省开展的一次社区综合预防运动，在 7 天内覆盖了 47000 人，提供艾滋病毒检测和咨询、水过滤器、经杀虫剂处理的蚊帐、避孕套，以及为艾滋病毒感染者提供复方新诺明预防和转介进行持续护理。我们对扩大综合预防运动的潜在成本效益进行了建模。
我们根据基线死亡率和发病率以及干预措施的保护效果（包括抗逆转录病毒疗法）的相关已发表数据，估算了可避免的死亡人数和残疾调整生命年（DALYs）。我们纳入了先前估计的扩大规模的运动成本。我们使用医疗保健成本的已发表数据，估算了避免疾病（针对所有三种疾病）和更早开始治疗艾滋病毒疾病过程中所节省的费用。
每 1000 名参与者，预计腹泻、疟疾和艾滋病毒感染病例减少可避免约 16.3 人死亡、359 个 DALYs 和 85113 美元的医疗费用。对艾滋病毒感染者的更早治疗预计可避免 82 个 DALYs（总计 442 个），费用为 37097 美元（将避免的总费用降低到 48015 美元）。考虑到估计的运动成本为 32000 美元，运动每 1000 名参与者可节省约 16015 美元。在多变量敏感性分析中，83%的模拟结果导致净节省，93%的模拟结果为每避免一个 DALY 的成本低于 20 美元。
大规模、快速实施的艾滋病毒检测、安全用水和疟疾控制运动在经济上具有吸引力。
