坦桑尼亚基于社区的1,7疟疾反应性检测与应对（1,7-mRCTR）方法：成本效益分析

The 1,7-malaria reactive community-based testing and response (1,7-mRCTR) approach in Tanzania: a cost-effectiveness analysis.

作者信息

Tampi Radhika Pradip, Wang Duoquan, Abdulla Salim, Mahende Muhidin Kassim, Gavana Tegemeo, Msuya Hajirani M, Kuwawenaruwa Augustine, Mihayo Michael, Brown Felix, Masanja Honorati, Anthony Wilbald, Bruxvoort Katia, Kihwele Fadhila, Chila Godlove, Chang Wei, Castro Marcia, Ning Xiao, Chaki Prosper P, Mlacha Yeromin P, Cohen Jessica, Menzies Nicolas A

机构信息

Program in Health Policy, Harvard University, Cambridge, MA, USA.

National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Center for Tropical Diseases, National Center for International Research On Tropical Diseases, Shanghai, China.

出版信息

Infect Dis Poverty. 2024 Dec 4;13(1):92. doi: 10.1186/s40249-024-01261-w.

DOI:10.1186/s40249-024-01261-w

PMID:39633463

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11619255/

Abstract

BACKGROUND

Reactive case detection (RACD) for malaria control has been found effective in low transmission settings, but its impact and cost-effectiveness in moderate-to-high transmission settings are unknown. We conducted an economic evaluation alongside an empirical trial of a modified RACD strategy (1,7-mRCTR) in three moderate-to-high malaria transmission districts in Tanzania.

METHODS

The costs and cost savings associated with the intervention relative to passive case detection alone were estimated in the study sites of Kilwa, Kibiti, and Rufiji districts in Tanzania from 2019-2021. Empirical cost data were collected using household surveys. The incremental costs of the intervention were calculated from under a societal perspective. Costs are reported in 2022 US dollars. Trial data and malaria registers from health facilities were used to calculate the number of malaria cases detected. We simulated unobserved and distal health effects of the intervention to assess cost-effectiveness in terms of incremental cost-effectiveness ratios (ICERs). Propagated uncertainty was assessed via second-order Monte Carlo simulation, including bootstrapping of empirical data distributions. Incremental costs per disability-adjusted life year (DALY) averted were compared to a willingness-to-pay threshold based on estimated opportunity costs of healthcare spending in Tanzania.

RESULTS

The programmatic cost of the 1,7-mRCTR intervention was 5327 United States Dollars (USD) per 1000 population. The combination of reactive and passive case detection in the intervention arm resulted in an additional 445 malaria cases detected per 1000 compared to passive detection alone, yielding an incremental cost per additional case detected of 12.0 USD. Based on modelling results, for every percentage point decline in malaria prevalence, the intervention averted 95.2 cases and 0.04 deaths per 1000 population. On average, the 1,7-mRCTR intervention averted 19.1 DALYs per 1000 population. Compared to passive malaria detection, the ICERs for the 1,7-mRCTR intervention were 7.3 USD per case averted, 16,884 USD per death averted, and 163 USD per DALY averted.

CONCLUSIONS

Our analysis demonstrates that the 1,7-mRCTR intervention appears to be cost-effective under a willingness-to-pay threshold of 417 USD per DALY averted, showing that modified RACD strategies can provide value for money in moderate-to-high transmission settings.

摘要

背景

疟疾控制中的反应性病例检测（RACD）在低传播环境中已被证明有效，但其在中高传播环境中的影响和成本效益尚不清楚。我们在坦桑尼亚的三个中高疟疾传播地区对一种改良的RACD策略（1,7-mRCTR）进行了实证试验，并同时进行了经济评估。

方法

2019年至2021年，在坦桑尼亚的基尔瓦、基比蒂和鲁菲吉地区的研究地点，估计了与干预措施相对于仅被动病例检测相关的成本和成本节约。通过家庭调查收集实证成本数据。从社会角度计算干预措施的增量成本。成本以2022年美元报告。利用卫生设施的试验数据和疟疾登记册来计算检测到的疟疾病例数。我们模拟了干预措施未观察到的和远端的健康影响，以根据增量成本效益比（ICER）评估成本效益。通过二阶蒙特卡罗模拟评估传播的不确定性，包括对实证数据分布进行自助抽样。将每避免一个伤残调整生命年（DALY）的增量成本与基于坦桑尼亚医疗保健支出估计机会成本的支付意愿阈值进行比较。

结果

1,7-mRCTR干预措施的项目成本为每1000人口5327美元。与仅被动检测相比，干预组中反应性和被动性病例检测相结合，每1000人额外检测到445例疟疾病例，每额外检测到一例病例的增量成本为12.0美元。根据模型结果，疟疾患病率每下降一个百分点，每1000人口中该干预措施可避免95.2例病例和0.04例死亡。平均而言，1,7-mRCTR干预措施每1000人口可避免19.1个DALY。与被动疟疾检测相比，1,7-mRCTR干预措施的ICER分别为每避免一例病例7.3美元、每避免一例死亡16884美元和每避免一个DALY 163美元。