Mathematical Ecology Research Group, Department of Zoology, University of Oxford, South Parks Road, Oxford, OX1 3PS, UK.
Malar J. 2018 Apr 24;17(1):174. doi: 10.1186/s12936-018-2321-6.
The sterile insect technique and transgenic equivalents are considered promising tools for controlling vector-borne disease in an age of increasing insecticide and drug-resistance. Combining vector interventions with artemisinin-based therapies may achieve the twin goals of suppressing malaria endemicity while managing artemisinin resistance. While the cost-effectiveness of these controls has been investigated independently, their combined usage has not been dynamically optimized in response to ecological and epidemiological processes.
An optimal control framework based on coupled models of mosquito population dynamics and malaria epidemiology is used to investigate the cost-effectiveness of combining vector control with drug therapies in homogeneous environments with and without vector migration. The costs of endemic malaria are weighed against the costs of administering artemisinin therapies and releasing modified mosquitoes using various cost structures. Larval density dependence is shown to reduce the cost-effectiveness of conventional sterile insect releases compared with transgenic mosquitoes with a late-acting lethal gene. Using drug treatments can reduce the critical vector control release ratio necessary to cause disease fadeout.
Combining vector control and drug therapies is the most effective and efficient use of resources, and using optimized implementation strategies can substantially reduce costs.
在杀虫剂和抗药性不断增加的时代，无菌昆虫技术和转基因等同物被认为是控制病媒传播疾病的有前途的工具。将病媒干预与青蒿素类疗法相结合，可能实现抑制疟疾地方性流行和管理青蒿素耐药性的双重目标。虽然这些控制措施的成本效益已经被独立研究过，但它们的联合使用并没有根据生态和流行病学过程进行动态优化。
基于蚊虫种群动态和疟疾流行病学耦合模型的最优控制框架，研究了在有和没有媒介迁移的同质环境中，将病媒控制与药物疗法相结合的成本效益。将疟疾地方性流行的成本与青蒿素疗法的管理成本以及使用各种成本结构释放改良蚊子的成本进行权衡。幼虫密度依赖性降低了与具有晚期致死基因的转基因蚊子相比，常规无菌昆虫释放的成本效益。使用药物治疗可以降低导致疾病消退所需的临界病媒控制释放比例。
结合病媒控制和药物治疗是最有效和最有效的资源利用方式，并且使用优化的实施策略可以大大降低成本。
