青蒿素-萘酚喹与青蒿琥酯-咯萘啶治疗巴布亚新几内亚儿童无并发症疟疾的成本效益比较。
Cost-effectiveness of artemisinin-naphthoquine versus artemether-lumefantrine for the treatment of uncomplicated malaria in Papua New Guinean children.
机构信息
School of Pharmacy, Curtin University of Technology, Perth, WA, Australia.
School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.
出版信息
Malar J. 2017 Oct 30;16(1):438. doi: 10.1186/s12936-017-2081-8.
BACKGROUND
A recent randomized trial showed that artemisinin-naphthoquine (AN) was non-inferior to artemether-lumefantrine (AL) for falciparum malaria and superior for vivax malaria in young Papua New Guinean children. The aim of this study was to compare the cost-effectiveness of these two regimens.
METHODS
An incremental cost-effectiveness analysis was performed using data from 231 children with Plasmodium falciparum and/or Plasmodium vivax infections in an open-label, randomized, parallel-group trial. Recruited children were randomized 1:1 to receive once daily AN for 3 days with water or twice daily AL for 3 days given with fat. World Health Organisation (WHO) definitions were used to determine clinical/parasitological outcomes. The cost of transport between the home and clinic, plus direct health-care costs, served as a basis for determining each regimen's incremental cost per incremental treatment success relative to AL by Day 42 and its cost per life year saved.
RESULTS
In the usual care setting, AN was more effective for the treatment of uncomplicated malaria in children aged 0.5-5.9 years. AL and AN were equally efficacious for the treatment of falciparum malaria, however AN had increased anti-malarial treatment costs per patient of $10.46, compared with AL. AN was the most effective regimen for treatment of vivax malaria, but had increased treatment costs of $14.83 per treatment success compared with AL.
CONCLUSIONS
Whilst AN has superior overall efficacy for the treatment of uncomplicated malaria in PNG children, AL was the less costly regimen. An indicative extrapolation estimated the cost per life year saved by using AN instead of AL to treat uncomplicated malaria to be $12,165 for girls and $12,469 for boys (discounted), which means AN may not be cost-effective and affordable for PNG at current cost. However, AN may become acceptable should it become WHO prequalified and/or should donated/subsidized drug supply become available.
背景
最近一项随机试验表明，青蒿素-萘酚喹（AN）在治疗恶性疟原虫感染和间日疟原虫感染方面与青蒿琥酯-咯萘啶（AL）疗效相当，且对巴布亚新几内亚儿童的间日疟原虫感染疗效更佳。本研究旨在比较这两种方案的成本效益。
方法
采用一项开放标签、随机、平行分组试验中的 231 例有恶性疟原虫和/或间日疟原虫感染的儿童数据，进行增量成本效益分析。招募的儿童按照 1:1 比例随机分为每天服用 3 天的青蒿素-萘酚喹一水合物组或每天服用 2 次的 AL 组，同时服用脂肪餐。采用世界卫生组织（WHO）的定义来确定临床/寄生虫学结局。以交通成本（往返诊所的交通费用）加上直接医疗保健成本作为基础，确定相对于第 42 天的 AL，每种方案的增量成本和每挽救一个生命年的增量成本。
结果
在常规护理环境下，AN 对 0.5-5.9 岁儿童的无并发症疟疾治疗更为有效。AL 和 AN 对治疗恶性疟原虫感染的疗效相当，但 AN 的抗疟治疗成本比 AL 高 10.46 美元/例。AN 是治疗间日疟原虫感染最有效的方案，但与 AL 相比，每获得一次治疗成功的治疗成本增加了 14.83 美元。
结论
尽管 AN 对巴布亚新几内亚儿童无并发症疟疾的总体疗效较好，但 AL 的成本较低。一项指示性外推估计，使用 AN 治疗无并发症疟疾替代 AL 治疗可使生命年获益成本增加 12165 美元（女孩）和 12469 美元（男孩）（折扣后），这意味着在当前成本下，AN 对巴布亚新几内亚来说可能不具有成本效益和可负担性。然而，如果 AN 获得世界卫生组织预认证，或如果获得捐赠/补贴药物供应，AN 可能会变得更能被接受。
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