Klein Eili Y, Smith David L, Cohen Justin M, Laxminarayan Ramanan
Center for Disease Dynamics, Economics and Policy, Washington, DC, USA Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA.
Department of Zoology, University of Oxford, Oxford, UK Sanaria Institute for Global Health & Tropical Medicine, Rockville, MD, USA.
J R Soc Interface. 2015 Jun 6;12(107). doi: 10.1098/rsif.2014.1356.
The Affordable Medicines Facility for malaria (AMFm) was conceived as a global market-based mechanism to increase access to effective malaria treatment and prolong effectiveness of artemisinin. Although results from a pilot implementation suggested that the subsidy was effective in increasing access to high-quality artemisinin combination therapies (ACTs), the Global Fund has converted AMFm into a country-driven mechanism whereby individual countries could choose to fund the subsidy from within their country envelopes. Because the initial costs of the subsidy in the pilot countries was higher than expected, countries are also exploring alternatives to a universal subsidy, such as subsidizing only child doses. We examined the incremental cost-effectiveness of a child-targeted policy using an age-structured bioeconomic model of malaria from the provider perspective. Because the vast majority of malaria deaths occur in children, targeting children could potentially improve the cost-effectiveness of the subsidy, though it would avert significantly fewer deaths. However, the benefits of a child-targeted subsidy (i.e. deaths averted) are eroded as leakage (i.e. older individuals taking young child-targeted doses) increases, with few of the benefits of a universal subsidy gained (i.e. reductions in overall prevalence). Although potentially more cost-effective, a child-targeted subsidy must contain measures to reduce the possibility of leakage.
疟疾平价药品机制（AMFm）被构想为一种基于全球市场的机制，以增加获得有效疟疾治疗的机会并延长青蒿素的有效性。尽管试点实施的结果表明，该补贴在增加获得高质量青蒿素联合疗法（ACTs）的机会方面是有效的，但全球基金已将AMFm转变为一种由国家驱动的机制，即各个国家可以选择从其国家资金范围内为补贴提供资金。由于试点国家补贴的初始成本高于预期，各国也在探索普遍补贴的替代方案，例如仅补贴儿童剂量。我们从提供者的角度，使用疟疾的年龄结构生物经济模型，研究了针对儿童政策的增量成本效益。由于绝大多数疟疾死亡发生在儿童中，针对儿童可能会提高补贴的成本效益，尽管它避免的死亡人数会显著减少。然而，随着漏用（即年龄较大的个体服用针对幼儿的剂量）增加，针对儿童的补贴的益处（即避免的死亡）会被侵蚀，几乎无法获得普遍补贴的益处（即总体患病率的降低）。尽管针对儿童的补贴可能更具成本效益，但必须包含减少漏用可能性的措施。
