Jordan H, Dunt D, Hollingsworth B, Firestone S M, Burgman M
Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia.
Division of Health Research, Faculty of Health and Medicine, Furness College, Lancaster University, Lancaster, UK.
Transbound Emerg Dis. 2016 Oct;63(5):e301-12. doi: 10.1111/tbed.12305. Epub 2014 Dec 7.
Governments are routinely involved in the biosecurity of agricultural and food imports and exports. This involves controlling the complex ongoing threat of the broad range of zoonoses: endemic, exotic and newly emerging. Policy-related decision-making in these areas requires accurate information and predictions concerning the effects and potential impacts of zoonotic diseases. The aim of this article was to provide information concerning the development and use of utility-based tools, specifically disability-adjusted life years (DALYs), for measuring the burden on human disease (morbidity and mortality) as a consequence of zoonotic infections. Issues and challenges to their use are also considered. Non-monetary utility approaches that are reviewed in this paper form one of a number of tools that can be used to estimate the monetary and non-monetary 'cost' of morbidity- and mortality-related consequences. Other tools derive from cost-of-illness, willingness-to-pay and multicriteria approaches. Utility-based approaches are specifically designed to capture the pain, suffering and loss of functioning associated with diseases, zoonotic and otherwise. These effects are typically complicated to define, measure and subsequently 'cost'. Utility-based measures will not be able to capture all of the effects, especially those that extend beyond the health sector. These will more normally be captured in financial terms. Along with other uncommon diseases, the quality of the relevant epidemiological data may not be adequate to support the estimation of losses in utility as a result of zoonoses. Other issues in their use have been identified. New empirical studies have shown some success in addressing these issues. Other issues await further study. It is concluded that, bearing in mind all caveats, utility-based methods are important tools in assessing the magnitude of the impacts of zoonoses in human disease. They make an important contribution to decision-making and priority setting across all sectors. In doing so, they highlight the relative importance of the burden of zoonotic disease globally.
政府通常会参与农业和食品进出口的生物安全事务。这涉及控制广泛的人畜共患病所带来的复杂且持续存在的威胁，包括地方性、外来性和新出现的人畜共患病。这些领域与政策相关的决策需要有关人畜共患病影响和潜在冲击的准确信息及预测。本文旨在提供有关基于效用的工具（特别是伤残调整生命年，即DALYs）的开发和使用的信息，以衡量人畜共患病感染导致的人类疾病负担（发病率和死亡率）。同时也考虑了其使用过程中存在的问题和挑战。本文所综述的非货币效用方法是可用于估计与发病率和死亡率相关后果的货币和非货币“成本”的众多工具之一。其他工具则源于疾病成本法、支付意愿法和多标准方法。基于效用的方法专门用于衡量与疾病（包括人畜共患病及其他疾病）相关的痛苦、折磨和功能丧失。这些影响通常难以定义、测量并随后进行“成本”核算。基于效用的衡量方法无法涵盖所有影响，尤其是那些超出卫生部门范畴的影响。这些影响通常会以财务术语进行核算。与其他罕见疾病一样，相关流行病学数据的质量可能不足以支持对人畜共患病导致的效用损失进行估计。在其使用过程中还发现了其他问题。新的实证研究在解决这些问题方面已取得了一些成功。其他问题有待进一步研究。结论是，尽管存在所有限制条件，但基于效用的方法仍是评估人畜共患病对人类疾病影响程度的重要工具。它们对所有部门的决策制定和优先事项设定都做出了重要贡献。通过这样做，它们凸显了全球人畜共患病负担的相对重要性。
