Department of Experimental and Clinical Medicine, University of Florence, Italy; Referral Center for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
Department of Experimental and Clinical Medicine, University of Florence, Italy.
Travel Med Infect Dis. 2020 Jul-Aug;36:101561. doi: 10.1016/j.tmaid.2020.101561. Epub 2020 Jan 23.
The Italian and the European Centre for Disease Control and Prevention guidelines both recommend a systematic serological screening for strongyloidiasis in sub-Saharan migrants (SSA), however, studies on clinical and economic impact of this strategy in the Italian and European settings are lacking.
A population of 100,000 migrants from SSA to Italy was considered and a Markov decision tree model was developed to assess the clinical and economic impact of two interventions for strongyloidiasis compared with the current practice (passive diagnosis of symptomatic cases): a) universal serological screening and treatment with ivermectin in case of positive test b) universal presumptive treatment with ivermectin. One and 10-year time horizon in the health-care perspective were considered.
In the one and 10-year time horizon respectively the costs for passive diagnosis was €1,164,169 and €9,735,908, those for screening option was € 2,856,011 and € 4,959,638 and those for presumptive treatment was €3,538,474 and € 4,883,272. Considering the cost per cured subject in the one-year time horizon, screening appears more favorable (€209.53), than the other two options (€232.55 per presumptive treatment and €10,197.29 per current strategy). Incremental cost-effectiveness ratio (ICERs) of screening strategy and presumptive treatment were respectively 265.27 and 333.19. The sensitivity analysis identified strongyloidiasis' prevalence as the main driver of ICER.
Compared to the current practice (passive diagnosis) both screening and presumptive treatment strategies are more favorable from a cost-effectiveness point of view, with a slight advantage of the screening strategy in a one-year time horizon.
意大利和欧洲疾病预防控制中心指南均建议对来自撒哈拉以南非洲的移民进行系统性血清学筛查以检测钩虫病，然而，关于该策略在意大利和欧洲环境中的临床和经济影响的研究尚缺乏。
考虑了一个由 10 万名来自撒哈拉以南非洲的移民组成的人群，并开发了一个马尔可夫决策树模型，以评估两种钩虫病干预措施（针对症状性病例的被动诊断）与当前实践相比的临床和经济影响：a）对所有移民进行血清学筛查，阳性者使用伊维菌素治疗；b）对所有移民进行伊维菌素推定治疗。在卫生保健视角下，考虑了 1 年和 10 年的时间范围。
在 1 年和 10 年的时间范围内，被动诊断的成本分别为 1164169 欧元和 9735908 欧元，筛查方案的成本分别为 2856011 欧元和 4959638 欧元，推定治疗的成本分别为 3538474 欧元和 4883272 欧元。在 1 年的时间范围内，考虑每个治愈患者的成本，筛查方案（209.53 欧元）比其他两种方案（推定治疗方案为 232.55 欧元，当前策略为 10197.29 欧元）更有利。筛查策略和推定治疗的增量成本效益比（ICER）分别为 265.27 和 333.19。敏感性分析确定了钩虫病的患病率是 ICER 的主要驱动因素。
与当前的实践（被动诊断）相比，从成本效益的角度来看，筛查和推定治疗策略均更具优势，在 1 年的时间范围内，筛查策略略有优势。
