Mationg Mary Lorraine S, Williams Gail M, Tallo Veronica L, Olveda Remigio M, Aung Eindra, Alday Portia, Reñosa Mark Donald, Daga Chona Mae, Landicho Jhoys, Demonteverde Maria Paz, Santos Eunice Diane, Bravo Thea Andrea, Bourke Siobhan, Munira Syarifah Liza, Bieri Franziska Angly, Li Yuesheng S, Clements Archie C A, Steinmann Peter, Halton Kate, Stewart Donald E, McManus Donald P, Gray Darren J
National Center for Epidemiology and Population Health, The Australian National University, Canberra, Australia.
Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines.
Lancet Reg Health West Pac. 2022 Sep 22;31:100597. doi: 10.1016/j.lanwpc.2022.100597. eCollection 2023 Feb.
Soil-transmitted helminth (STH) infections are a significant public health problem affecting over 900 million people globally. Health education has been shown to complement mass drug administration (MDA) for the control of these intestinal worms. We reported recently results of a cluster randomised control trial (RCT) showing the positive impact of the "The Magic Glasses Philippines (MGP)" health education package in reducing STH infections among schoolchildren in intervention schools with ≤15% STH baseline prevalence in Laguna province, the Philippines. To inform decision making on the economic implications of the MGP, we evaluated the in-trial costs and then quantified the costs of scaling up the intervention both regionally and nationally.
Costs were determined for the MGP RCT conducted in 40 schools in Laguna province. We estimated the total cost and the costs incurred per student for the actual RCT and the total costs for regional and national scale-up in all schools regardless of STH endemicity. The costs associated with the implementation of standard health education (SHE) activities and mass drug administration (MDA) were determined with a public sector perspective.
The cost per participating student in the MGP RCT was Php 58.65 (USD 1.15) but if teachers instead of research staff had been involved, the estimated cost would have been considerably lower at Php 39.45 (USD 0.77). Extrapolating the costs for regional scale-up, the costs per student were estimated to be Php 15.24 (USD 0.30). As it is scaled up at the national level to include more schoolchildren, the estimated cost was increased at Php 17.46 (USD 0.34). In scenario 2 and 3, consistently, labour/salary costs associated with the delivery of the MGP contributed most to overall programme expenditure. Furthermore, the estimated average cost per student for SHE and MDA were Php 117.34 (USD 2.30) and Php 58.17 (USD 1.14), respectively. Using national scale up estimates, the cost of combining the MGP with SHE and MDA was Php 192.97 (USD 3.79).
These findings suggest that the integration of MGP into the school curriculum would be an affordable and scalable approach to respond to the continuous burden of STH infection among schoolchildren in the Philippines.
National and Medical Research Council, Australia, and the UBS-Optimus Foundation, Switzerland.
土壤传播的蠕虫感染是一个重大的公共卫生问题，全球有超过9亿人受其影响。健康教育已被证明可辅助群体药物驱虫（MDA）来控制这些肠道蠕虫。我们最近报告了一项整群随机对照试验（RCT）的结果，该试验表明“菲律宾魔法眼镜（MGP）”健康教育套餐对菲律宾拉古纳省基线蠕虫感染率≤15%的干预学校的学童减少土壤传播蠕虫感染有积极影响。为了为关于MGP经济影响的决策提供信息，我们评估了试验中的成本，然后对在区域和国家层面扩大该干预措施的成本进行了量化。
确定了在拉古纳省40所学校进行的MGP RCT的成本。我们估计了实际RCT的总成本和每名学生的成本，以及所有学校无论蠕虫流行情况如何在区域和国家层面扩大规模的总成本。从公共部门的角度确定了与实施标准健康教育（SHE）活动和群体药物驱虫（MDA）相关的成本。
MGP RCT中每名参与学生的成本为58.65菲律宾比索（1.15美元），但如果由教师而非研究人员参与，估计成本会低得多，为39.45菲律宾比索（0.77美元）。推断区域扩大规模的成本，每名学生的成本估计为15.24菲律宾比索（0.30美元）。在国家层面扩大规模以纳入更多学童时，估计成本增加到17.46菲律宾比索（0.34美元）。在方案2和3中，与实施MGP相关的劳动力/工资成本始终是总体项目支出的最大贡献者。此外，SHE和MDA每名学生的估计平均成本分别为117.34菲律宾比索（2.30美元）和58.17菲律宾比索（1.14美元）。使用国家层面扩大规模的估计值，将MGP与SHE和MDA相结合的成本为192.97菲律宾比索（3.79美元）。
这些结果表明，将MGP纳入学校课程将是应对菲律宾学童持续面临的土壤传播蠕虫感染负担的一种经济实惠且可扩展的方法。
澳大利亚国家和医学研究委员会以及瑞士瑞银集团 - 奥普蒂默斯基金会。
