Maheu-Giroux Mathieu, Castro Marcia C
Department of Global Health & Population, Harvard School of Public Health, Boston, MA, USA.
Malar J. 2014 Dec 4;13:477. doi: 10.1186/1475-2875-13-477.
Larviciding for malaria control can contribute to an Integrated Vector Management (IVM) approach. This intervention is currently supported in settings where breeding habitats are 'few, fixed, and findable', such as urban areas of sub-Saharan Africa, but the knowledge base regarding the cost-effectiveness of larviciding is non-existent.
Programme costs and effectiveness data were collected from the Dar es Salaam Urban Malaria Control Programme in Tanzania. Cost-effectiveness ratios (CER) were estimated from the provider and societal perspectives for standard indicators using different malaria transmission scenarios.
CER for microbial larviciding were highly dependent on the assumed baseline malaria incidence rates. Using the societal perspective, net CER were estimated (in 2012 US dollars) at $43 (95% uncertainty intervals [UI]: $15-181) per disability-adjusted life year averted (DALY) when malaria incidence was 902 infections per 1,000 individuals, increasing to $545 (95% UI: $337-1,558) per DALY at an incidence of 122 per 1,000. Larviciding was shown to be cost-effective in Tanzania for incidences as low as 40 infections per 1,000 people per year.
This is believed to be the first study to estimate the cost-effectiveness of larviciding for urban malaria control in sub-Saharan Africa. The results support the use of larviciding as a cost-effective intervention in urban areas and managers of national malaria control programme should consider this intervention as part of an IVM approach.
使用杀幼虫剂控制疟疾有助于采用综合病媒管理（IVM）方法。目前，在撒哈拉以南非洲城市地区等繁殖栖息地“数量少、位置固定且易于发现”的环境中，这种干预措施得到了支持，但关于杀幼虫剂成本效益的知识库尚不存在。
从坦桑尼亚达累斯萨拉姆城市疟疾控制项目收集项目成本和效果数据。使用不同的疟疾传播情景，从提供者和社会角度估算标准指标的成本效益比（CER）。
微生物杀幼虫剂的CER高度依赖于假定的基线疟疾发病率。从社会角度来看，当疟疾发病率为每1000人902例感染时，避免每例伤残调整生命年（DALY）的净CER估计为43美元（95%不确定区间[UI]：15 - 181美元），发病率为每1000人122例时，每DALY增加到545美元（95% UI：337 - 1558美元）。在坦桑尼亚，杀幼虫剂被证明对于低至每年每1000人40例感染的发病率具有成本效益。
据信这是第一项估计撒哈拉以南非洲城市疟疾控制中杀幼虫剂成本效益的研究。结果支持将杀幼虫剂作为城市地区具有成本效益的干预措施使用，国家疟疾控制项目的管理者应将此干预措施视为IVM方法的一部分。
