Department of Epidemiology, University of Washington, Seattle, WA, USA.
Trop Med Int Health. 2013 Aug;18(8):916-24. doi: 10.1111/tmi.12127. Epub 2013 May 10.
To estimate the effectiveness, costs and cost-effectiveness of providing long-lasting insecticide-treated nets (LLINs) and point-of-use water filters to antiretroviral therapy (ART)-naïve HIV-infected adults and their family members, in the context of a multisite study in Kenya of 589 HIV-positive adults followed on average for 1.7 years.
The effectiveness, costs and cost-effectiveness of the intervention were estimated using an epidemiologic-cost model. Model epidemiologic inputs were derived from the Kenya multisite study data, local epidemiological data and from the published literature. Model cost inputs were derived from published literature specific to Kenya. Uncertainty in the model estimates was assessed through univariate and multivariate sensitivity analyses.
We estimated net cost savings of about US$ 26 000 for the intervention, over 1.7 years. Even when ignoring net cost savings, the intervention was found to be very cost-effective at a cost of US$ 3100 per death averted or US$ 99 per disability-adjusted life year (DALY) averted. The findings were robust to the sensitivity analysis and remained most sensitive to both the duration of ART use and the cost of ART per person-year.
The provision of LLINs and water filters to ART-naïve HIV-infected adults in the Kenyan study resulted in substantial net cost savings, due to the delay in the initiation of ART. The addition of an LLIN and a point-of-use water filter to the existing package of care provided to ART-naïve HIV-infected adults could bring substantial cost savings to resource-constrained health systems in low- and middle-income countries.
在肯尼亚的一项多中心研究中，对 589 名接受抗逆转录病毒治疗（ART）的 HIV 阳性成年人进行了平均 1.7 年的随访，评估向 HIV 感染成人及其家庭成员提供长效驱虫蚊帐（LLINs）和即用水处理过滤器的有效性、成本和成本效益。
采用流行病学成本模型估计干预措施的有效性、成本和成本效益。模型流行病学输入数据来源于肯尼亚多中心研究数据、当地流行病学数据和已发表的文献。模型成本输入数据来源于特定于肯尼亚的已发表文献。通过单变量和多变量敏感性分析评估模型估计的不确定性。
我们估计，在 1.7 年的时间里，该干预措施将节省约 26000 美元的净成本。即使忽略净成本节约，该干预措施仍非常具有成本效益，每避免 1 人死亡的成本为 3100 美元，每避免 1 个残疾调整生命年（DALY）的成本为 99 美元。敏感性分析结果稳健，且发现该结果对 ART 使用时间和每人每年的 ART 成本均最为敏感。
在肯尼亚的研究中，向未接受 ART 的 HIV 感染成人提供长效驱虫蚊帐和水过滤器，由于延迟了 ART 的开始，因此导致了大量的净成本节约。在向未接受 ART 的 HIV 感染成人提供的现有护理方案中增加长效驱虫蚊帐和即用水处理过滤器，可以为资源有限的中低收入国家的卫生系统节省大量成本。
