College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Graduate School of Professional Studies, St. Mary's University of Minnesota, Minneapolis, MN, USA.
Epidemiol Infect. 2019 Aug 9;147:e252. doi: 10.1017/S0950268819001420.
This study recognises periodic outbreaks of measles continue to affect conflict and fragile zones in the least developed countries. This study set out to provide evidence for the indirect costs or economic loss associated with measles-related deaths among children aged 0-14 years in Somalia. Using epidemiologic and economic data, the indirect cost was calculated based on the framework of the World Health Organisation guide of identifying the economic consequences of disease and injury. The baseline indirect cost was computed as the product of discounted future productive years of life lost (PYLL), non-health gross domestic product per capita (NHGDPPC) and the estimated total measles deaths (ETMD). The model was adjusted for conflict and fragility conditions and further extension considered a finite and stable upper limit growth of the instability-adjusted NHGDPPC. To discount future costs, a rate of 3% was applied. Using a ±20% variability assumption of the epidemiologic and economic factor inputs, a sensitivity analysis was conducted to account for uncertainty. In 2015 values, the ETMD of 3723 measles deaths of children aged 0-14 years could decrease non-health GDP of the country by $23.46 million, a potential loss of $6303 per death over the discounted PYLL. The loss would increase by 5.3% when adjusted for conflict and fragility conditions. Assuming growth, the future adjusted loss is expected to be $35.91 million in 2015 values. Girl-child deaths accounted for 51.2% of the burden. Results are robust to the variations in the model inputs, although sensitivity analyses suggest the proportion of total measles deaths and the discount rate accounted for greater uncertainty of the loss than do the proportion of growth and instability assumption. Conflict and fragility accounted for the least uncertainty, perhaps confirming their relative perpetuity in Somalia. Results show significant indirect cost related to measles deaths of children, exacerbated by conflict and fragility. This is an economic burden, but one which the health system, policy-makers, government and other stakeholders should be prepared to colossally discount by collectively taking measles surveillance and security measures now to reduce further deaths in the future.
这项研究认识到，麻疹的周期性爆发继续影响着最不发达国家的冲突和脆弱地区。本研究旨在提供证据，证明在索马里，0-14 岁儿童因麻疹相关死亡而造成的间接成本或经济损失。使用流行病学和经济数据，根据世界卫生组织确定疾病和伤害经济后果指南的框架，计算了间接成本。基线间接成本是通过贴现未来丧失的生产性年限（PYLL）、每人均非卫生国内生产总值（NHGDPPC）和估计的总麻疹死亡人数（ETMD）的乘积计算得出的。该模型考虑了冲突和脆弱条件的调整，并进一步扩展考虑了不稳定调整后的 NHGDPPC 的有限和稳定的上限增长。为了贴现未来成本，应用了 3%的贴现率。根据流行病学和经济因素投入的±20%的可变性假设，进行了敏感性分析，以考虑不确定性。按 2015 年的价值计算，3723 名 0-14 岁儿童的麻疹死亡人数可能使该国非卫生 GDP 减少 2346 万美元，每例死亡的潜在损失为贴现 PYLL 的 6303 美元。如果考虑到冲突和脆弱条件的调整，损失将增加 5.3%。假设增长，2015 年按现行值计算，未来调整后的损失预计为 3591 万美元。女童死亡占负担的 51.2%。尽管敏感性分析表明，总麻疹死亡人数和贴现率的比例比增长率和不稳定性假设的比例对损失的不确定性更大，但模型投入的变化使结果保持稳健。冲突和脆弱性造成的不确定性最小，这或许证实了它们在索马里的相对永久性。结果表明，与儿童麻疹死亡相关的间接成本巨大，而且由于冲突和脆弱性而加剧。这是一种经济负担，但卫生系统、决策者、政府和其他利益攸关方应该做好准备，通过现在共同采取麻疹监测和安全措施，来大大降低这一负担，以减少未来的进一步死亡。
