赞比亚南部省份疟疾大规模群体检测与治疗干预措施的成本及成本效益

Costs and cost-effectiveness of a large-scale mass testing and treatment intervention for malaria in Southern Province, Zambia.

作者信息

Silumbe Kafula, Yukich Joshua O, Hamainza Busiku, Bennett Adam, Earle Duncan, Kamuliwo Mulakwa, Steketee Richard W, Eisele Thomas P, Miller John M

机构信息

Malaria Control and Evaluation Partnership in Africa (PATH-MACEPA), Lusaka, Zambia.

Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.

出版信息

Malar J. 2015 May 20;14:211. doi: 10.1186/s12936-015-0722-3.

BACKGROUND

A cluster, randomized, control trial of three dry-season rounds of a mass testing and treatment intervention (MTAT) using rapid diagnostic tests (RDTs) and artemether-lumefantrine (AL) was conducted in four districts in Southern Province, Zambia.

METHODS

Data were collected on the costs and logistics of the intervention and paired with effectiveness estimated from a community randomized control trial for the purpose of conducting a provider perspective cost-effectiveness analysis of MTAT vs no MTAT (Standard of Care).

RESULTS

Dry-season MTAT in this setting did not reduce malaria transmission sufficiently to permit transition to a case-investigation strategy to then pursue malaria elimination, however, the intervention did substantially reduce malaria illness and was a highly cost-effective intervention for malaria burden reduction in this moderate transmission area. The cost per RDT administered was estimated to be USD4.39 (range: USD1.62-13.96) while the cost per AL treatment administered was estimated to be USD34.74 (range: USD3.87-3,835). The net cost per disability adjusted life year averted (incremental cost-effectiveness ratio) was estimated to be USD804.

CONCLUSIONS

The intervention appears to be highly cost-effective relative to World Health Organization thresholds for malaria burden reduction in Zambia as compared to no MTAT. However, it was estimated that population-wide mass drug administration is likely to be more cost-effective for burden reduction and for transmission reduction compared to MTAT.

背景

在赞比亚南部省份的四个地区开展了一项整群随机对照试验，对采用快速诊断检测（RDT）和蒿甲醚-本芴醇（AL）进行的三轮旱季大规模检测和治疗干预（MTAT）进行研究。

方法

收集了干预措施的成本和后勤数据，并与一项社区随机对照试验估计的有效性数据相结合，目的是从提供者角度对MTAT与不进行MTAT（标准治疗）进行成本效益分析。

结果

在这种情况下，旱季MTAT未能充分减少疟疾传播，从而无法过渡到病例调查策略以进而实现疟疾消除，然而，该干预措施确实大幅减少了疟疾发病，并且对于在这个中度传播地区减轻疟疾负担而言是一项具有高成本效益的干预措施。每次使用RDT的估计成本为4.39美元（范围：1.62 - 13.96美元），而每次使用AL进行治疗的估计成本为34.74美元（范围：3.87 - 3835美元）。每避免一个伤残调整生命年的净成本（增量成本效益比）估计为804美元。