Politi C, Carrín G, Evans D, Kuzoe F A, Cattand P D
Division of Intensified Cooperation with Countries, WHO, Geneva, Switzerland.
Health Econ. 1995 Jul-Aug;4(4):273-87. doi: 10.1002/hec.4730040404.
African trypanosomiasis, or sleeping sickness, is a tropical disease caused by trypanosome parasites transmitted by tsetse flies. The focus of this paper is on the cost-effectiveness of alternative drug treatments for patients in the late stage of the disease. Melarsoprol has been used for many decades. More recently, eflornithine has been developed. It has fewer side effects and improves the overall cure rate. It is much more expensive than melarsoprol, however. The objective of the present cost-effectiveness is to identify the costs and benefits that would be involved in switching from melarsoprol to eflornithine in the treatment of late stage sleeping sickness. Benefits are expressed in lives saved as well as in disability adjusted life years (DALYs). The analysis is applied to the case of Uganda. The implications for affordability are also considered, by taking account of how the treatment costs would be shared between the national government, donors and patients. The baseline results indicate that melarsoprol treatment is associated with an incremental cost per life and DALY saved of $209 and $8, respectively. Each additional life saved by switching from melarsoprol alone to a combination of melarsoprol and eflornithine would cost an extra $1,033 per life saved, and an extra $40.9 per DALY gained. Shifting from this second alternative to treatment of all patients with eflornithine leads to an incremental cost per life saved of $4,444 and an incremental cost of $166.8 per DALY gained.
非洲锥虫病，即昏睡病，是一种由采采蝇传播的锥虫寄生虫引起的热带疾病。本文的重点是针对该疾病晚期患者的替代药物治疗的成本效益。美拉胂醇已使用了数十年。最近，依氟鸟氨酸被研发出来。它的副作用较少，且提高了总体治愈率。然而，它比美拉胂醇贵得多。当前成本效益分析的目的是确定在治疗晚期昏睡病时从美拉胂醇改用依氟鸟氨酸所涉及的成本和收益。收益以挽救的生命数量以及伤残调整生命年（DALYs）来表示。该分析应用于乌干达的情况。通过考虑治疗成本将如何在国家政府、捐助者和患者之间分担，还考虑了可负担性的影响。基线结果表明，美拉胂醇治疗每挽救一条生命和一个DALY的增量成本分别为209美元和8美元。从仅使用美拉胂醇改为美拉胂醇与依氟鸟氨酸联合使用，每多挽救一条生命将额外花费1033美元，每多获得一个DALY将额外花费40.9美元。从第二种方案转向使用依氟鸟氨酸治疗所有患者，每挽救一条生命的增量成本为4444美元，每多获得一个DALY的增量成本为166.8美元。
