非洲萨赫勒次区域季节性疟疾化学预防：成本效益和成本节约分析。

Seasonal malaria chemoprevention in the Sahel subregion of Africa: a cost-effectiveness and cost-savings analysis.

机构信息

Management Sciences for Health, Arlington, VA, USA.

University of Ghana School of Public Health, Accra, Ghana.

出版信息

Lancet Glob Health. 2021 Feb;9(2):e199-e208. doi: 10.1016/S2214-109X(20)30475-7.

DOI:10.1016/S2214-109X(20)30475-7

PMID:33482140

Abstract

BACKGROUND

The intermittent administration of seasonal malaria chemoprevention (SMC) is recommended to prevent malaria among children aged 3-59 months in areas of the Sahel subregion in Africa. However, the cost-effectiveness and cost savings of SMC have not previously been evaluated in large-scale studies.

METHODS

We did a cost-effectiveness and cost-savings analysis of a large-scale, multi-country SMC campaign with sulfadoxine-pyrimethamine plus amodiaquine for children younger than 5 years in seven countries in the Sahel subregion (Burkina Faso, Chad, Guinea, Mali, Niger, Nigeria, and The Gambia) in 2016. The financial and economic costs were analysed from the programmatic perspective and are reported in 2016 US$ for each country. The estimated numbers of averted malaria cases, deaths, and disability-adjusted life-years (DALYs) were based on numbers of SMC treatments administered and modelled malaria transmission. Cost savings were calculated from a programmatic perspective corresponding to the diagnostic and treatment costs for malaria cases averted.

FINDINGS

The total cost of SMC for all seven countries was $22·8 million, and the weighted average economic cost of administering four monthly SMC cycles was $3·63 per child (ranging from $2·71 in Niger to $8·20 in The Gambia). Based on 80% modelled effectiveness of SMC, the incremental economic cost per malaria case averted ranged from $2·91 in Niger to $30·73 in The Gambia; the cost per severe case averted ranged from $119·63 in Niger to $506·00 in The Gambia; the cost per death averted ranged from $533·56 in Niger to $2256·92 in The Gambia; and the cost per DALY averted (discounted by 3%) ranged from $18·66 in Niger to $78·91 in The Gambia. The estimated total economic cost savings to the health systems in all seven countries were US$66·0 million and the total net economic cost savings were US$43·2 million.

INTERPRETATION

SMC is a low-cost and highly cost-effective intervention that contributes to substantial cost savings by reducing malaria diagnostic and treatment costs among children.

FUNDING

Unitaid.

摘要

背景

间歇性季节性疟疾化学预防（SMC）的给药方式，是推荐用于预防撒哈拉以南非洲萨赫勒次区域 3-59 月龄儿童疟疾的方法。然而，之前并未在大规模研究中评估 SMC 的成本效益和成本节约情况。

方法

我们对撒哈拉以南非洲七个国家（布基纳法索、乍得、几内亚、马里、尼日尔、尼日利亚和冈比亚）于 2016 年开展的一项大规模多国 SMC 运动（使用磺胺多辛-乙胺嘧啶加阿莫地喹治疗 5 岁以下儿童）进行了成本效益和成本节约分析。从方案角度分析了财务和经济成本，并按各国 2016 年的美元报告了每个国家的成本。估计的疟疾发病、死亡和残疾调整生命年（DALY）数量是基于 SMC 治疗管理数量和疟疾传播模型。从方案角度计算了节约的成本，对应于避免的疟疾病例的诊断和治疗费用。

发现

所有七个国家的 SMC 总成本为 2280 万美元，每个儿童平均（在尼日尔为 2.71 美元，在冈比亚为 8.20 美元）进行四次每月 SMC 周期的加权平均经济成本为 3.63 美元。基于 SMC 80%的模型有效性，每例疟疾发病避免的增量经济成本从尼日尔的 2.91 美元到冈比亚的 30.73 美元不等；每例严重病例避免的成本从尼日尔的 119.63 美元到冈比亚的 506.00 美元不等；每例死亡避免的成本从尼日尔的 533.56 美元到冈比亚的 2256.92 美元不等；每例 DALY 避免（按 3%贴现）的成本从尼日尔的 18.66 美元到冈比亚的 78.91 美元不等。所有七个国家的卫生系统估计可节省的总经济成本为 6600 万美元，净经济成本节约为 4320 万美元。