增加坦桑尼亚男性自愿接受医学性环切术人数的需求创造干预措施的成本和成本效益：花更多的钱省更多的钱。
Cost and Cost-Effectiveness of a Demand Creation Intervention to Increase Uptake of Voluntary Medical Male Circumcision in Tanzania: Spending More to Spend Less.
机构信息
Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom.
National Institute for Medical Research (NIMR), Mwanza, Tanzania.
出版信息
J Acquir Immune Defic Syndr. 2018 Jul 1;78(3):291-299. doi: 10.1097/QAI.0000000000001682.
BACKGROUND
Although voluntary medical male circumcision (VMMC) reduces the risk of HIV acquisition, demand for services is lower among men in most at-risk age groups (ages 20-34 years). A randomized controlled trial was conducted to assess the effectiveness of locally-tailored demand creation activities (including mass media, community mobilization, and targeted service delivery) in increasing uptake of campaign-delivered VMMC among men aged 20-34 years. We conducted an economic evaluation to understand the intervention's cost and cost-effectiveness.
SETTING
Tanzania (Njombe and Tabora regions).
METHODS
Cost data were collected on surgery, demand creation activities, and monitoring and supervision related to VMMC implementation across clusters in both trial arms, as well as start-up activities for the intervention arms. The Decision Makers' Program Planning Tool was used to estimate the number of HIV infections averted and related cost savings, given the total VMMCs per cluster. Disability-adjusted life years were calculated and used to estimate incremental cost-effectiveness ratios.
RESULTS
Client load was higher in the intervention arms than in the control arms: 4394 vs. 2901 in Tabora and 1797 vs. 1025 in Njombe, respectively. Despite additional costs of tailored demand creation, demand increased more than proportionally: mean costs per VMMC in the intervention arms were $62 in Tabora and $130 in Njombe, and in the control arms $70 and $191, respectively. More infections were averted in the intervention arm than in the control arm in Tabora (123 vs. 67, respectively) and in Njombe (164 vs. 102, respectively). The intervention dominated the control because it was both less costly and more effective. Cost savings were observed in both regions stemming from the antiretroviral treatment costs averted as a result of the VMMCs performed.
CONCLUSIONS
Spending more to address local preferences as a way to increase uptake of VMMC can be cost-saving.
背景
虽然自愿男性包皮环切术（VMMC）可降低艾滋病毒感染的风险，但在大多数高危年龄组（20-34 岁）的男性中，对服务的需求较低。一项随机对照试验评估了针对当地需求创造活动（包括大众媒体、社区动员和针对性服务提供）在增加 20-34 岁男性参与宣传推广的 VMMC 中的效果。我们进行了一项经济评估，以了解干预措施的成本和成本效益。
地点
坦桑尼亚（Njombe 和 Tabora 地区）。
方法
在试验组的每个群组中，对与 VMMC 实施相关的手术、需求创造活动以及监测和监督方面收集了成本数据，还对干预组的启动活动进行了成本收集。决策者规划工具用于根据每个群组的 VMMC 总数来估计可避免的艾滋病毒感染数量和相关成本节约。使用残疾调整生命年来计算并用于估计增量成本效益比。
结果
干预组的客户负荷高于对照组：Tabora 分别为 4394 例和 2901 例，Njombe 分别为 1797 例和 1025 例。尽管有针对性的需求创造活动的额外成本，但需求的增长超过了比例：干预组的每例 VMMC 的平均成本分别为 Tabora 为 62 美元和 Njombe 为 130 美元，对照组分别为 70 美元和 191 美元。Tabora 地区干预组比对照组多预防了 123 例感染（分别为 123 例和 67 例），而 Njombe 地区则多预防了 164 例感染（分别为 164 例和 102 例）。干预组优于对照组，因为它的成本更低，效果更好。由于实施的 VMMC 而避免了抗逆转录病毒治疗费用，在两个地区都观察到了成本节约。
结论
为了满足当地需求而增加支出以提高 VMMC 的接受度可以节省成本。
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