Network Systems Science and Advanced Computing Division, Biocomplexity Institute, University of Virginia, Charlottesville, Virginia, USA.
Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA.
BMJ Glob Health. 2021 Nov;6(11). doi: 10.1136/bmjgh-2021-006424.
The global progress against malaria has slowed significantly since 2017. As the current malaria control tools seem insufficient to get the trend back on track, several clinical trials are investigating ivermectin mass drug administration (iMDA) as a potential additional vector control tool; however, the health impacts and cost-effectiveness of this new strategy remain unclear.
We developed an analytical tool based on a full factorial experimental design to assess the potential impact of iMDA in nine high burden sub-Saharan African countries. The simulated iMDA regimen was assumed to be delivered monthly to the targeted population for 3 months each year from 2023 to 2027. A broad set of parameters of ivermectin efficacy, uptake levels and global intervention scenarios were used to predict averted malaria cases and deaths. We then explored the potential averted treatment costs, expected implementation costs and cost-effectiveness ratios under different scenarios.
In the scenario where coverage of malaria interventions was maintained at 2018 levels, we found that iMDA in these nine countries has the potential to reverse the predicted growth of malaria burden by averting 20-50 million cases and 36 000-90 000 deaths with an assumed efficacy of 20%. If iMDA has an efficacy of 40%, we predict between 40-99 million cases and 73 000-179 000 deaths will be averted with an estimated net cost per case averted between US$2 and US$7, and net cost per death averted between US$1460 and US$4374.
This study measures the potential of iMDA to reverse the increasing number of malaria cases for several sub-Saharan African countries. With additional efficacy information from ongoing clinical trials and country-level modifications, our analytical tool can help determine the appropriate uptake strategies of iMDA by calculating potential marginal gains and costs under different scenarios.
自 2017 年以来，全球抗击疟疾的进展明显放缓。由于当前的疟疾控制手段似乎不足以使趋势重回正轨，几项临床试验正在研究伊维菌素大规模药物管理（iMDA）作为一种潜在的额外的病媒控制手段；然而，这种新策略的健康影响和成本效益仍不清楚。
我们开发了一种基于完全析因实验设计的分析工具，以评估 iMDA 在九个撒哈拉以南非洲高负担国家的潜在影响。模拟的 iMDA 方案假设从 2023 年到 2027 年，每年针对目标人群每月进行一次，持续 3 个月。我们使用了广泛的伊维菌素疗效、吸收率和全球干预方案参数来预测可预防的疟疾病例和死亡人数。然后，我们探讨了在不同情况下可避免的治疗费用、预期实施费用和成本效益比。
在假设 2018 年疟疾干预措施的覆盖率保持不变的情况下，我们发现这九个国家的 iMDA 有可能通过预防 2000 万至 5000 万例疟疾病例和 36000 至 90000 例死亡来扭转预测的疟疾负担增长，假设疗效为 20%。如果 iMDA 的疗效为 40%，我们预计将预防 4000 万至 9900 万例疟疾病例和 73000 至 179000 例死亡，预计每例可预防病例的净成本在 2 至 7 美元之间，每例可预防死亡的净成本在 1460 至 4374 美元之间。
本研究衡量了 iMDA 在几个撒哈拉以南非洲国家逆转不断增加的疟疾病例数量的潜力。随着来自正在进行的临床试验的额外疗效信息和国家层面的调整，我们的分析工具可以通过计算不同情况下的潜在边际收益和成本，帮助确定 iMDA 的适当采用策略。
