Lee Bruce Y, Bartsch Sarah M, Stone Nathan T B, Zhang Shufang, Brown Shawn T, Chatterjee Chandrani, DePasse Jay V, Zenkov Eli, Briët Olivier J T, Mendis Chandana, Viisainen Kirsi, Candrinho Baltazar, Colborn James
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Pittsburgh Supercomputing Center, Carnegie Mellon University, Pittsburgh, Pennsylvania.
Am J Trop Med Hyg. 2017 Jun;96(6):1430-1440. doi: 10.4269/ajtmh.16-0744.
AbstractMalaria-endemic countries have to decide how much of their limited resources for vector control to allocate toward implementing long-lasting insecticidal nets (LLINs) versus indoor residual spraying (IRS). To help the Mozambique Ministry of Health use an evidence-based approach to determine funding allocation toward various malaria control strategies, the Global Fund convened the Mozambique Modeling Working Group which then used JANUS, a software platform that includes integrated computational economic, operational, and clinical outcome models that can link with different transmission models (in this case, OpenMalaria) to determine the economic value of vector control strategies. Any increase in LLINs (from 80% baseline coverage) or IRS (from 80% baseline coverage) would be cost-effective (incremental cost-effectiveness ratios ≤ $114/disability-adjusted life year averted). However, LLIN coverage increases tend to be more cost-effective than similar IRS coverage increases, except where both pyrethroid resistance is high and LLIN usage is low. In high-transmission northern regions, increasing LLIN coverage would be more cost-effective than increasing IRS coverage. In medium-transmission central regions, changing from LLINs to IRS would be more costly and less effective. In low-transmission southern regions, LLINs were more costly and less effective than IRS, due to low LLIN usage. In regions where LLINs are more cost-effective than IRS, it is worth considering prioritizing LLIN coverage and use. However, IRS may have an important role in insecticide resistance management and epidemic control. Malaria intervention campaigns are not a one-size-fits-all solution, and tailored approaches are necessary to account for the heterogeneity of malaria epidemiology.
摘要
疟疾流行国家必须决定如何在其有限的病媒控制资源中分配资金，以用于实施长效驱虫蚊帐（LLINs）还是室内滞留喷洒（IRS）。为帮助莫桑比克卫生部采用基于证据的方法来确定对各种疟疾控制策略的资金分配，全球基金召集了莫桑比克建模工作组，该工作组随后使用了JANUS软件平台，该平台包括综合计算经济、运营和临床结果模型，这些模型可以与不同的传播模型（在本案例中为OpenMalaria）相链接，以确定病媒控制策略的经济价值。长效驱虫蚊帐（从80%的基线覆盖率开始增加）或室内滞留喷洒（从80%的基线覆盖率开始增加）的任何增加都将具有成本效益（增量成本效益比≤114美元/避免的伤残调整生命年）。然而，长效驱虫蚊帐覆盖率的增加往往比类似的室内滞留喷洒覆盖率增加更具成本效益，除非拟除虫菊酯抗性高且长效驱虫蚊帐使用率低的情况。在高传播的北部地区，增加长效驱虫蚊帐覆盖率比增加室内滞留喷洒覆盖率更具成本效益。在中等传播的中部地区，从长效驱虫蚊帐转向室内滞留喷洒将成本更高且效果更差。在低传播的南部地区，由于长效驱虫蚊帐使用率低，长效驱虫蚊帐比室内滞留喷洒成本更高且效果更差。在长效驱虫蚊帐比室内滞留喷洒更具成本效益的地区，值得考虑优先提高长效驱虫蚊帐的覆盖率和使用率。然而，室内滞留喷洒在杀虫剂抗性管理和疫情控制方面可能发挥重要作用。疟疾干预措施并非一刀切的解决方案，需要采用量身定制的方法来考虑疟疾流行病学的异质性。
