Evans T G, Murray C J
Soc Sci Med. 1987;25(3):241-9. doi: 10.1016/0277-9536(87)90227-9.
This article is a critical re-examination of the recent cost-effectiveness analysis of the Onchocerciasis Control Programme (OCP) in West Africa, undertaken by Prost and Prescott in 1984. We use the same approach, namely, measuring effectiveness of the programme by the number of healthy years of life added by the prevention of blindness. This work focuses on certain technical aspects of the data used for estimating parameter values in the cost-effectiveness calculations. Through examination of available data and the relationships between certain key variables, we estimate values that differ substantially from Prost and Prescott for the population at risk, the incidence and prevalence of onchocercal blindness, and the years of healthy life lost due to blindness. Our final results suggest that depending on the discount rate that the OCP is 7-40 times more costly as measured by discounted years of productive life added than measles immunisation. These results are in contradiction to Prost and Prescott's estimation that the OCP was more cost-effective than measles immunisation. We, however, feel that our results do not demonstrate that OCP is an inefficient use of resources. Rather, they call into question the methods used and the relevance of comparing measles immunisation and onchocerciasis control. In a subsequent article, we hope to deal directly with these conceptual problems by presenting separate humanitarian and economic cost-effectiveness measures.
本文是对普罗斯特和普雷斯科特于1984年对西非盘尾丝虫病控制计划（OCP）所做的近期成本效益分析的批判性重新审视。我们采用相同的方法，即通过预防失明所增加的健康寿命年数来衡量该计划的成效。这项工作聚焦于成本效益计算中用于估计参数值的数据的某些技术方面。通过审查现有数据以及某些关键变量之间的关系，我们对高危人群、盘尾丝虫性失明的发病率和患病率以及因失明而损失的健康寿命年数所估计的值与普罗斯特和普雷斯科特的估计值有很大差异。我们的最终结果表明，根据贴现率的不同，以增加的贴现生产寿命年数来衡量，OCP的成本比麻疹免疫高7至40倍。这些结果与普罗斯特和普雷斯科特关于OCP比麻疹免疫更具成本效益的估计相矛盾。然而，我们认为我们的结果并未表明OCP是对资源的低效利用。相反，它们对所使用的方法以及比较麻疹免疫和盘尾丝虫病控制的相关性提出了质疑。在后续文章中，我们希望通过提出单独的人道主义和经济成本效益措施来直接处理这些概念性问题。
