Wellcome Centre for Integrative Parasitology, Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, G12 8QQ, UK.
Centro de Investigação Em Saúde de Manhiça, Maputo, Mozambique.
Malar J. 2021 Mar 10;20(1):143. doi: 10.1186/s12936-021-03687-1.
As malaria cases increase in some of the highest burden countries, more strategic deployment of new and proven interventions must be evaluated to meet global malaria reduction goals.
The cost and cost-effectiveness of indoor residual spraying (IRS) with pirimiphos-methyl (Actellic®300 CS) were assessed in a high transmission district (Mopeia) with high access to pyrethroid insecticide-treated nets (ITNs), compared to ITNs alone. The major mosquito vectors in the area were susceptible to primiphos-methyl, but resistant to pyrethoids. A decision analysis approach was followed to conduct deterministic and probabilistic sensitivity analyses in a theoretical cohort of 10,000 children under five years of age (U5) and 10,000 individuals of all ages, separately. Model parameters and distributions were based on prospectively collected cost and epidemiological data from a cluster-randomized control trial and a literature review. The primary analysis used health facility-malaria incidence, while community cohort incidence and cross-sectional prevalence rates were used in sensitivity analyses. Lifetime costs, malaria cases, deaths and disability-adjusted life-years (DALYs) were calculated to determine the incremental costs per DALY averted through IRS.
The average IRS cost per person protected was US$8.26 and 51% of the cost was insecticide. IRS averted 46,609 (95% CI 46,570-46,646) uncomplicated and 242 (95% CI 241-243) severe lifetime cases in a theoretical children U5 cohort, yielding an incremental cost-effectiveness ratio (ICER) of US$400 (95% CI 399-402) per DALY averted. In the all-age cohort, the ICER was higher: US$1,860 (95% CI 1,852-1,868) per DALY averted. Deterministic and probabilistic results were consistent. When adding the community protective effect of IRS, the cost per person protected decreased (US$7.06) and IRS was highly cost-effective in children U5 (ICER = US$312) and cost-effective in individuals of all ages (ICER = US$1,431), compared to ITNs alone.
This study provides robust evidence that IRS with pirimiphos-methyl can be cost-effective in high transmission regions with high pyrethroid ITN coverage where the major vector is susceptible to pirimiphos-methyl but resistant to pyrethroids. The finding that insecticide cost is the main driver of IRS costs highlights the need to reduce the insecticide price without jeopardizing effectiveness.
ClinicalTrials.gov identifier NCT02910934 (Registered 22 September 2016). https://clinicaltrials.gov/ct2/show/NCT02910934?term=NCT02910934&draw=2&rank=1.
随着一些疟疾负担最重的国家疟疾病例的增加，必须评估新的和经过验证的干预措施的更具战略性的部署，以实现全球疟疾减少目标。
在一个高传播地区（莫皮亚）评估了使用派卡瑞丁（Actellic®300 CS）进行室内滞留喷洒（IRS）的成本和成本效益，该地区的吡虫啉驱虫蚊帐（ITN）的获取途径很高，与单独使用 ITN 进行了比较。该地区的主要蚊子传播媒介对派卡瑞丁敏感，但对拟除虫菊酯有抗药性。采用决策分析方法，分别对 10,000 名五岁以下儿童（U5）和 10,000 名所有年龄段的个体进行了理论队列的确定性和概率敏感性分析。模型参数和分布基于前瞻性收集的成本和来自一项随机对照试验和文献综述的流行病学数据。主要分析使用了医疗机构疟疾发病率，而社区队列发病率和横断面患病率则用于敏感性分析。计算了终生成本、疟疾病例、死亡和残疾调整生命年（DALY），以确定 IRS 避免的每个 DALY 的增量成本。
每保护一个人所需的 IRS 平均成本为 8.26 美元，其中 51%是杀虫剂的成本。IRS 避免了 U5 儿童理论队列中 46,609 例（95%CI 46,570-46,646）的非复杂性和 242 例（95%CI 241-243）严重的终生病例，产生了每避免一个 DALY 的增量成本效益比（ICER）为 400 美元（95%CI 399-402）。在所有年龄段的队列中，ICER 更高：每避免一个 DALY 的增量成本为 1860 美元（95%CI 1,852-1,868）。确定性和概率结果是一致的。当加入 IRS 的社区保护作用时，人均保护成本降低（7.06 美元），IRS 在儿童 U5 中具有很高的成本效益（ICER=312 美元），在所有年龄段的个体中也具有成本效益（ICER=1431 美元），与单独使用 ITN 相比。
这项研究提供了有力的证据，证明在高传播地区，当主要媒介对派卡瑞丁敏感但对拟除虫菊酯有抗药性，并且吡虫啉 ITN 覆盖率较高时，使用派卡瑞丁进行 IRS 可以具有成本效益。杀虫剂成本是 IRS 成本的主要驱动因素，这一发现强调了需要降低杀虫剂价格而又不损害效果的必要性。
ClinicalTrials.gov 标识符 NCT02910934（2016 年 9 月 22 日注册）。https://clinicaltrials.gov/ct2/show/NCT02910934?term=NCT02910934&draw=2&rank=1.
