National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China.
Chinese Center for Tropical Diseases Research, Shanghai, China.
Infect Dis Poverty. 2021 Dec 22;10(1):136. doi: 10.1186/s40249-021-00917-1.
Clonorchiasis is attributed to the ingestion of raw freshwater fish harboring Clonorchis sinensis. Morbidity control is targeted through the administration of antihelminthics. This study modelled the cost yield indicated by effectiveness and utility of different treatment strategies against clonorchiasis.
About 1000 participants were enrolled from each of 14 counties selected from four provincial-level administrative divisions namely Guangxi, Guangdong, Heilongjiang and Jilin in 2017. Fecal examination was adopted to detect C. sinensis infection, while behavior of ingesting raw freshwater fish was enquired. Counties were grouped into four categories based on prevalence, namely low prevalence group (< 1%), moderate prevalence group (1-9.9%), high prevalence group (10-19.9%) and very high prevalence group (≥ 20%), while population were divided into three subgroups, namely children aged below 14 years old, adult female and adult male both aged over 14 years old. The average of cost effectiveness indicated by the cost to treat single infected cases with C. sinensis and of cost utility indicated by the cost to avoid per disability-adjusted life years (DALYs) caused by C. sinensis infection was calculated. Comparisons were performed between three treatment schedules, namely individual treatment, massive and selective chemotherapy, in which different endemic levels and populations were considered.
In selective chemotherapy strategy, the cost to treat single infected case in very high prevalence group was USD 10.6 in adult male, USD 11.6 in adult female, and USD 13.2 in children. The cost increased followed the decrease of endemic level. In massive chemotherapy strategy, the cost per infected case in very high prevalence group was USD 14.0 in adult male, USD 17.1 in adult female, USD 45.8 in children, which were also increased when the endemic level decreased. In individual treatment strategy, the cost was USD 12.2 in adult male, USD 15.0 in adult female and USD 41.5 in children in very high prevalence group; USD 19.2 in adult male, USD 34.0 in adult female, and USD 90.1 in children in high prevalence group; USD 30.4 in adult male, USD 50.5 in adult female and over USD 100 in children in moderate prevalence group; and over USD 400 in any population in low prevalence group. As to cost utility, the differences by treatment strategies, populations and endemic levels were similar to those in cost effectiveness.
Both cost effectiveness and cost utility indicators are highly impacted by the prevalence and population, as well as the treatment schedules. Adults especially men in the areas with a prevalence over 10% should be prioritized, in which selective chemotherapy was best and massive chemotherapy was also cost effective. In moderate endemic areas, the yield is not ideal, but selective chemotherapy for adult male may also be adopted. In low endemic areas, all strategies were high costly and new strategies need to be developed.
华支睾吸虫病是由于食用含有华支睾吸虫的生淡水鱼而引起的。通过驱虫治疗来控制发病率。本研究通过评估不同治疗策略对华支睾吸虫病的有效性和效用，建立了成本效益模型。
2017 年，从广西、广东、黑龙江和吉林四个省级行政区的 14 个县各招募约 1000 名参与者。采用粪便检查检测华支睾吸虫感染情况，询问生食淡水鱼的行为。根据流行率将各县分为四类，即低流行率组（<1%）、中流行率组（1-9.9%）、高流行率组（10-19.9%）和极高流行率组（≥20%），而人群分为三组，即年龄在 14 岁以下的儿童、年龄在 14 岁以上的成年女性和成年男性。计算了治疗单个华支睾吸虫感染病例的成本效益（以治疗单个感染病例的成本表示）和避免每例因华支睾吸虫感染导致的残疾调整生命年（DALYs）的成本效用（以避免每个 DALYs 的成本表示）。比较了三种治疗方案，即个体治疗、大规模和选择性化疗，同时考虑了不同的流行水平和人群。
在选择性化疗策略中，极高流行率组中成年男性、成年女性和儿童每例感染的治疗成本分别为 10.6 美元、11.6 美元和 13.2 美元。治疗成本随着流行水平的降低而增加。在大规模化疗策略中，极高流行率组中每个感染病例的治疗成本分别为成年男性 14.0 美元、成年女性 17.1 美元和儿童 45.8 美元，当流行水平降低时，治疗成本也会增加。在个体治疗策略中，极高流行率组中成年男性、成年女性和儿童的治疗成本分别为 12.2 美元、15.0 美元和 41.5 美元；高流行率组中成年男性、成年女性和儿童的治疗成本分别为 19.2 美元、34.0 美元和 90.1 美元；中流行率组中成年男性、成年女性和儿童的治疗成本分别为 30.4 美元、50.5 美元和 100 美元以上；低流行率组中任何人群的治疗成本均超过 400 美元。至于成本效用，治疗策略、人群和流行水平的差异与成本效益相似。
成本效益和成本效用指标都受到流行率和人群以及治疗方案的高度影响。流行率超过 10%的地区应优先考虑成年人，特别是男性，其中选择性化疗效果最佳，大规模化疗也具有成本效益。在中度流行地区，效果不理想，但也可以采用选择性化疗治疗成年男性。在低流行地区，所有策略都代价高昂，需要开发新策略。
