Michael E, Meyrowitsch D W, Simonsen P E
Department of Zoology, University of Cambridge, UK.
Trop Med Int Health. 1996 Aug;1(4):414-26. doi: 10.1046/j.1365-3156.1996.d01-82.x.
This study examines the costs and cost effectiveness of four different mass diethylcarbamazine (DEC) chemotherapy regimens-standard dose, semi-annual single dose, low monthly dose and DEC-medicated salt-in reducing microfilarial (mf) prevalence at the community level. Costs were estimated for each intervention in relation to both ingredient and activity, by the derivation and use of detailed itemized cost menus. The most expensive and most effective strategy in reducing community mf prevalence over 2 years was DEC salt intervention, followed in order of costs by the standard, low monthly and semi-annual DEC strategies. The most cost effective strategy was the low monthly DEC treatment. Cost and sensitivity analyses, however, suggest that the optimal choice of mass DEC strategy for reducing mf is very sensitive to programme design parameters. In particular, the results demonstrate that if the salt delivery structure is simplified, DEC salt has the potential to be the dominant intervention for filariasis control. The results suggest that economies of scale considerations might militate against the adoption of this intervention for large-scale applications, unless perhaps offset by its potential for cost recovery by direct patient purchase. Further analyses require a more realistic evaluation of filariasis intervention effectiveness by addressing changes in infection intensity and by accounting for the population dynamics of parasite transmission and control.
本研究考察了四种不同的乙胺嗪（DEC）群体化疗方案——标准剂量、半年单剂量、低月剂量以及含药盐——在社区层面降低微丝蚴（mf）流行率方面的成本及成本效益。通过推导和使用详细的分项成本清单，针对每种干预措施的成分和活动估算成本。在两年内降低社区mf流行率方面，最昂贵且最有效的策略是含药盐干预，按成本排序依次为标准、低月剂量和半年DEC策略。最具成本效益的策略是低月剂量DEC治疗。然而，成本和敏感性分析表明，降低mf的最佳群体DEC策略选择对项目设计参数非常敏感。特别是，结果表明，如果简化盐的供应结构，含药盐有可能成为控制丝虫病的主要干预措施。结果表明，规模经济的考虑因素可能不利于大规模采用这种干预措施，除非通过直接向患者收费来回收成本的潜力能够抵消这些因素。进一步的分析需要通过考虑感染强度的变化以及寄生虫传播和控制的种群动态，对丝虫病干预效果进行更现实的评估。
