He Yun-Ting, Huang Xiao-Hong, Fang Yue-Yi, Zeng Qing-Sheng, Li Lai-De, Luo Le, Lai Ying-Si
Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong Province, People's Republic of China.
Statistics Office of network data information department, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China.
PLoS Negl Trop Dis. 2022 May 23;16(5):e0010429. doi: 10.1371/journal.pntd.0010429. eCollection 2022 May.
Clonorchiasis is an important food-borne parasitic disease caused by Clonorchis sinensis infection. The evaluation of long-term cost-effectiveness of control strategies is important for disease control and prevention. The present study aimed to assess the cost-effectiveness of the three recommended strategies (i.e., WHO, Chinese and Guangdong strategies) and different combinations of commonly used measures (i.e., preventive chemotherapy, information, education, and communication (IEC) and environmental improvement) on clonorchiasis. The study area, Fusha town in Guangdong Province, was a typical high endemic area in China. The analysis was based on a multi-group transmission model of C. sinensis infection. We set the intervention duration for 10 years and post-intervention period for 50 years. The corresponding costs and DALYs were estimated. Strategies with incremental cost-effectiveness ratios (ICERs) less than 1/5 of the willingness-to-pay threshold were identified as highly cost-effective strategies. The optimal control strategy was obtained using the next best comparator method. The ICERs of Guangdong strategy were $172 (95% CI: $143-$230) US for praziquantel and $106 (95% CI: $85-$143) US for albendazole, suggesting the highest cost-effectiveness among the three recommended strategies. For praziquantel, 470 sets of control strategies were identified as highly cost-effective strategies for achieving infection control (prevalence<5%). The optimal strategy consisted of chemotherapy targeted on at-risk population, IEC and environmental improvement, with coverages all being 100%, and with the ICER of $202 (95% CI: $168-$271) US. The results for transmission control (prevalence<1%) and albendazole were obtained with the same procedures. The findings may help to develop control policies for C. sinensis infection in high endemic areas. Moreover, the method adopted is applicable for assessment of optimal strategies in other endemic areas.
华支睾吸虫病是一种由华支睾吸虫感染引起的重要食源性寄生虫病。评估控制策略的长期成本效益对于疾病控制和预防至关重要。本研究旨在评估三种推荐策略（即世界卫生组织、中国和广东策略）以及常用措施（即预防性化疗、信息、教育和宣传（IEC）以及环境改善）的不同组合对华支睾吸虫病的成本效益。研究区域为广东省福沙镇，是中国典型的高流行区。分析基于华支睾吸虫感染的多组传播模型。我们将干预持续时间设定为10年，干预后期设定为50年。估计了相应的成本和伤残调整生命年（DALYs）。增量成本效益比（ICERs）低于支付意愿阈值五分之一的策略被确定为高成本效益策略。使用次优比较器方法获得了最优控制策略。广东策略中吡喹酮的ICERs为172美元（95%置信区间：143 - 230美元），阿苯达唑为106美元（95%置信区间：85 - 143美元），表明在三种推荐策略中成本效益最高。对于吡喹酮，470套控制策略被确定为实现感染控制（患病率<5%）的高成本效益策略。最优策略包括针对高危人群的化疗、IEC和环境改善，覆盖率均为100%，ICER为202美元（95%置信区间：168 - 271美元）。通过相同程序获得了传播控制（患病率<1%）和阿苯达唑的结果。这些发现可能有助于制定高流行区华支睾吸虫感染的控制政策。此外，所采用的方法适用于评估其他流行区的最优策略。
