Lechat M F, Vellut C, Misson C B, Misson J Y
Int J Lepr Other Mycobact Dis. 1978 Jan-Mar;46(1):14-24.
The effectiveness of various control methods for reducing the incidence of leprosy have been tested over 20 years and compared with predictions made using the present current control method (early diagnosis and mass treatment). Specific vaccination of the whole population, a control measure yet to be developed, has been identified as the most effective strategy in the long run. A cost-effectiveness analysis has been carried out for three indicators, annual incidence, annual prevalence and cumulative prevalence at 20 years, using cumulative costs. The analysis indicates that specific vaccination at high levels of coverage is the most effective method for controlling incidence in the long term. Provided the cost of the vaccination campaign during the first years (roughly fourfold the funds required for carrying out the current strategy) can be supported, specific vaccination is also the most cost-effective method where a high level of effectiveness is required. Specific vaccination is still the most advantageous method if prevalence or cumulative prevalence are taken to indicate the effectiveness of leprosy control. The BCG-type of vaccination is not only less effective, it is also less cost-effective. Reducing the rate of abandonment of treatment (which in the model has been simulated by increasing the rate of resuming treatment) and earlier detection both appear as useful methods under conditions of severe budgetary constraints. Their ultimate effectiveness in terms of incidence reduction is, however, very small. As expected, segregation is costly and ineffective compared with other methods. In each simulation, the cost of treating the backlog of patients already ill or infected (incubating) at the time the control measures are initiated is high. Methods aimed at reducing transmission, such as vaccination, early treatment or segregation, have long-delayed effects on the cost even if incidence is reduced. The major cost item in these control measures is the prolonged or even life-long treatment of patients. The development of fast-acting, effective treatment is likely to be the only way to reduce the cost in the short term. Thus, in addition to research aimed at developing a vaccine for leprosy, resources should also be allocated for developing new therapeutics.
二十多年来，人们一直在测试各种控制方法对降低麻风发病率的效果，并与使用当前控制方法（早期诊断和大规模治疗）所做的预测进行比较。对全体人群进行特异性疫苗接种，这一尚未开发的控制措施，已被确定为从长远来看最有效的策略。使用累计成本，针对三个指标（年发病率、年患病率和20年累计患病率）进行了成本效益分析。分析表明，高覆盖率的特异性疫苗接种是长期控制发病率的最有效方法。如果能够承担头几年疫苗接种运动的成本（大致是实施当前策略所需资金的四倍），那么在需要高效益的情况下，特异性疫苗接种也是最具成本效益的方法。如果以患病率或累计患病率来衡量麻风控制的效果，特异性疫苗接种仍然是最具优势的方法。卡介苗类型的疫苗不仅效果较差，成本效益也较低。在预算严重受限的情况下，降低治疗中断率（在模型中通过提高重新开始治疗的比率来模拟）和更早发现病例似乎都是有用的方法。然而，它们在降低发病率方面的最终效果非常小。正如预期的那样，与其他方法相比，隔离成本高昂且效果不佳。在每次模拟中，在启动控制措施时治疗已患病或已感染（处于潜伏期）的患者积压病例的成本都很高。旨在减少传播的方法，如疫苗接种、早期治疗或隔离，即使发病率降低，对成本的影响也会延迟很久。这些控制措施中的主要成本项目是对患者的长期甚至终身治疗。开发速效、有效的治疗方法可能是短期内降低成本的唯一途径。因此，除了致力于开发麻风疫苗的研究之外，还应分配资源用于开发新的治疗方法。
