Foster S, Phillips M
Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, U.K.
Ann Trop Med Parasitol. 1998 Jun;92(4):391-8. doi: 10.1080/00034989859375.
About 5% of deaths worldwide are due to malaria, and 5% of the total disease burden among children is due to malaria. The burden is much greater in sub-Saharan Africa, with 15% of all disability-adjusted life-years (DALY) lost to malaria. Malaria is costly, too: an estimated U.S. $1800 million is spent annually on both direct costs of prevention and care, and on indirect costs such as lost productivity, time costs and other indirect costs and losses. There are several economic issues to be addressed with regard to malaria. For example, is malaria control important in comparison with other claims on scarce health resource? Secondly, which approach or strategy for prevention and treatment is most appropriate, given the local circumstances? Thirdly, within each strategy chosen (e.g. diagnosis and treatment of cases), which options are available and which is the best? Within the choice of strategy and design, other issues arise, such as the best options for prevention, and their cost. What strategy is best for case finding? How much should be spent on diagnostics? Under which circumstances does mass treatment make economic sense? When should a new, more expensive drug be used in cases of resistance? Perhaps most importantly, the overall approach needs to be reviewed to ensure that resources are being used to best effect. The role of economics in decision making is the subject of the present review.
全球约5%的死亡归因于疟疾，儿童疾病总负担的5%也归因于疟疾。撒哈拉以南非洲地区的负担要大得多，因疟疾损失了15%的伤残调整生命年（DALY）。疟疾的代价也很高：估计每年在预防和护理的直接成本以及生产力损失、时间成本和其他间接成本及损失等间接成本上花费18亿美元。关于疟疾，有几个经济问题需要解决。例如，与对稀缺卫生资源的其他需求相比，疟疾控制是否重要？其次，考虑到当地情况，哪种预防和治疗方法或策略最合适？第三，在所选的每种策略（如病例诊断和治疗）中，有哪些选择，哪种是最佳选择？在策略选择和设计范围内，还会出现其他问题，如预防的最佳选择及其成本。哪种策略最适合病例发现？应该在诊断上花费多少？在哪些情况下群体治疗具有经济意义？当出现耐药情况时，何时应使用新的、更昂贵的药物？也许最重要的是，需要审查总体方法，以确保资源得到最佳利用。经济学在决策中的作用是本综述的主题。
