以社区为基础的和住院治疗方案治疗埃塞俄比亚严重急性营养不良的成本效益分析。
Cost effectiveness of community-based and in-patient therapeutic feeding programs to treat severe acute malnutrition in Ethiopia.
机构信息
Jimma University Faculty of Public Health, P,O,Box 2082 code 1250 Addis Ababa, Ethiopia.
出版信息
Cost Eff Resour Alloc. 2012 Mar 19;10:4. doi: 10.1186/1478-7547-10-4.
BACKGROUND
This study estimated the cost effectiveness of community-based therapeutic care (CTC) for children with severe acute malnutrition (SAM) in Sidama Zone, Ethiopia compared to facility based therapeutic feeding center (TFC).
METHODS
A cost effectiveness analysis comparing costs and outcomes of two treatment programmes was conducted. The societal perspective, which considers costs to all sectors of the society, was employed. Outcomes and health service costs of CTC and TFC were obtained from Save the Children USA (SC/USA) CTC and TFC programme, government health services and UNICEF(in kind supplies) cost estimates of unit costs. Parental costs were estimated through interviewing 306 caretakers. Cost categories were compared and a single cost effectiveness ratio of costs to treat a child with SAM in each program (regardless of outcome) was computed and compared.
RESULTS
A total of 328 patient cards/records of children treated in the programs were reviewed; out of which 306 (157 CTC and 149 TFC) were traced back to their households to interview their caretakers. The cure rate in TFC was 95.36% compared to 94.30% in CTC. The death rate in TFC was 0% and in CTC 1.2%. The mean cost per child treated was $284.56 in TFC and $134.88 in CTC. The institutional cost per child treated was $262.62 in TFC and $128.58 in CTC. Out of these institutional costs in TFC 46.6% was personnel cost. In contrast, majority (43.2%) of the institutional costs in CTC went to ready to use therapeutic food (RUTF). The opportunity cost per caretaker in the TFC was $21.01 whereas it was $5.87 in CTC. The result of this study shows that community based CTC was two times more cost effective than TFC.
CONCLUSION
CTC was found to be relatively more cost effective than TFC in this setting. This indicates that CTC is a viable approach on just economic grounds in addition to other benefits such improved access, sustainability and appropriateness documented elsewhere. If costs of RUTF can be reduced such as through local production the CTC costs per child can be further reduced as RUTF constitutes the highest cost in these study settings.
背景
本研究旨在评估与机构为基础的治疗性喂养中心（TFC）相比，在埃塞俄比亚 Sidama 地区开展社区为基础的治疗性照护（CTC）对严重急性营养不良（SAM）儿童的成本效益。
方法
采用成本效益分析比较两种治疗方案的成本和效果。采用社会视角，即考虑社会各部门的成本。CTC 和 TFC 的效果和卫生服务成本来自美国救助儿童会（SC/USA）CTC 和 TFC 项目、政府卫生服务和儿基会（实物供应）单位成本估算。通过访谈 306 名照顾者来估算父母的成本。对成本类别进行比较，并计算和比较了每个方案中治疗 SAM 儿童的单一成本效益比（无论结果如何）。
结果
共查阅了两个项目中治疗的 328 名患儿的病历/记录；其中 306 名（157 名 CTC 和 149 名 TFC）患儿被追踪到他们的家庭，以访谈他们的照顾者。TFC 的治愈率为 95.36%，而 CTC 为 94.30%。TFC 的死亡率为 0%，而 CTC 为 1.2%。TFC 中每名儿童的治疗费用为 284.56 美元，而 CTC 中为 134.88 美元。TFC 中每名儿童的机构治疗费用为 262.62 美元，而 CTC 中为 128.58 美元。TFC 中机构成本的 46.6%是人员成本。相比之下，CTC 中机构成本的大部分（43.2%）用于即食治疗食品（RUTF）。TFC 中每名照顾者的机会成本为 21.01 美元，而 CTC 中为 5.87 美元。本研究结果表明，社区为基础的 CTC 比 TFC 更具成本效益。这表明，除了在其他方面具有可及性、可持续性和适宜性等益处外，CTC 在经济方面也是一种可行的方法。如果可以降低 RUTF 的成本，例如通过本地生产，那么 CTC 的每名儿童成本可以进一步降低，因为在这些研究环境中，RUTF 是成本最高的部分。
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