让疟疾诊断和治疗更贴近民众：在马达加斯加一个农村地区将疟疾社区病例管理扩展至所有年龄段的经济合理性

Bringing malaria diagnosis and treatment closer to the people: economic rationale for expanding malaria community case management to all ages in a rural district in Madagascar.

作者信息

Ochieng Walter, Gutman Julie R, Dentinger Catherine, Harimanana Aina, Irinantenaina Judickaelle, Razanadranaivo Hobisoa Léa, Raobela Oméga, Mukerabirori Aline, Kapesa Laurent, Garchitorena Andres, Steinhardt Laura

机构信息

Global Health Center, US Centers for Disease Control and Prevention, Atlanta, GA, USA.

National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, USA.

出版信息

Malar J. 2025 May 4;24(1):141. doi: 10.1186/s12936-025-05381-y.

DOI:10.1186/s12936-025-05381-y

PMID:40320532

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12049781/

Abstract

BACKGROUND

Expanding malaria community case management (mCCM) to all ages could shift the point-of-care to the community leading to improved healthcare access in underserved populations. This study assesses the economic viability of such an expansion in Farafangana district, Madagascar.

METHODS

A cluster-randomized trial was conducted across 30 health centres and the 502 community health workers (CHW) in their catchment areas, with the intervention arm implementing the age-expanded mCCM intervention. CHWs across both arms received training, supplies, and supervision to manage malaria. An economic evaluation assessed cost-effectiveness from health sector and societal perspectives, measuring outcomes in disability-adjusted life years (DALYs) averted. The impact of CHW compensation and economic risks were evaluated using sensitivity analyses.

RESULTS

Without CHW compensation, annual costs were $794,000, primarily for antimalarials and diagnostic tests. Incremental cost-effectiveness ratios (ICERs) per DALY averted ranged from -$21.86 to $212.42. From a societal perspective, the ICER was -$135.64, and -$243.29 including mortality benefits, meaning the intervention was cost-saving. The programme could avert 99.6 deaths and 3,721.7 DALYs annually, yielding $1,172,283 in net economic benefits. Sensitivity analyses supported these findings.

CONCLUSIONS

Age-expanded mCCM is highly cost-effective and can enhance malaria treatment access in resource-limited settings.

摘要

背景

将疟疾社区病例管理（mCCM）扩展至所有年龄段，可将医疗服务点转移至社区，从而改善服务不足人群的医疗保健可及性。本研究评估了在马达加斯加法拉方加纳区进行此类扩展的经济可行性。

方法

在30个卫生中心及其服务区域内的502名社区卫生工作者（CHW）中开展了一项整群随机试验，干预组实施年龄扩展的mCCM干预措施。两组的社区卫生工作者均接受了管理疟疾的培训、物资供应和监督。一项经济评估从卫生部门和社会角度评估了成本效益，以避免的伤残调整生命年（DALY）衡量结果。使用敏感性分析评估了社区卫生工作者薪酬和经济风险的影响。

结果

在没有社区卫生工作者薪酬的情况下，年度成本为79.4万美元，主要用于抗疟药物和诊断检测。每避免一个DALY的增量成本效益比（ICER）在-21.86美元至212.42美元之间。从社会角度来看，ICER为-135.64美元，包括死亡效益在内为-243.29美元，这意味着该干预措施具有成本节约效益。该项目每年可避免99.6例死亡和3721.7个DALY，产生1172283美元的净经济效益。敏感性分析支持了这些结果。