Graves P M
Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver 80262, USA.
Ann Trop Med Parasitol. 1998 Jun;92(4):399-410. doi: 10.1080/00034989859384.
The cost-effectiveness of two different methods of prevention of morbidity and mortality due to Plasmodium falciparum malaria, vaccination and impregnation of mosquito nets with permethrin, was compared. The analysis was performed with reference to the cohort of all children born in The Gambia in 1990 and protected for 5 years, using estimates of costs from studies in The Gambia. The vaccine was assumed to be given in three doses before the age of 6 months, through the Expanded Programme of Immunization, and to remain effective up to the age of 5 years. The bednets were assumed to be impregnated at 6-monthly intervals over the 5-year period. The expected number of deaths and attacks due to P. falciparum in the first 5 years of the 1990 cohort's lives were estimated from published literature. The numbers of deaths and attacks averted by the two strategies were then estimated by decision analysis, using the best estimates of effectiveness available in the literature. The vaccine strategy would have averted an estimated 743 deaths and 50,502 malaria attacks, whereas the net impregnation would have averted 1537 deaths and 69,415 attacks. The estimated cost per death averted was U.S. $252 for the vaccine and U.S. $711 for net impregnation. The estimated cost per P. falciparum attack averted was U.S. $3.71 for the vaccine and U.S. $15.75 for net impregnation. Sensitivity analysis, examining the effect of varying the vaccine cost or insecticide cost, the efficacy of the vaccine or net impregnation, and the percentage coverage of the population, confirmed the greater cost-effectiveness of the vaccine strategy for either of the outcomes examined under the conditions of the model. However, limitations on the absolute number of deaths and malaria attacks which can averted by currently available vaccines demonstrate that a vaccine of higher efficacy would be highly desirable.
比较了两种预防恶性疟原虫疟疾发病和死亡的不同方法（疫苗接种和用氯菊酯浸泡蚊帐）的成本效益。分析参照了1990年在冈比亚出生并得到5年保护的所有儿童队列，使用了冈比亚研究中的成本估算。假设疫苗通过扩大免疫规划在6个月龄前分三次接种，并在5岁前保持有效。假设蚊帐在5年期间每隔6个月浸泡一次。根据已发表的文献估算了1990年队列生命最初5年中因恶性疟原虫导致的预期死亡数和发病数。然后通过决策分析，利用文献中现有的最佳有效性估算值，估算了两种策略避免的死亡数和发病数。疫苗策略估计可避免743例死亡和50,502次疟疾发病，而蚊帐浸泡策略可避免1537例死亡和69,415次发病。疫苗预防每例死亡的估计成本为252美元，蚊帐浸泡为711美元。疫苗预防每次恶性疟原虫发病的估计成本为3.71美元，蚊帐浸泡为15.75美元。敏感性分析考察了疫苗成本或杀虫剂成本变化、疫苗或蚊帐浸泡效果以及人群覆盖率的影响，证实了在模型条件下所考察的任何一种结果中，疫苗策略的成本效益更高。然而，目前可用疫苗能够避免的死亡和疟疾发病绝对数量的限制表明，非常需要一种更高疗效的疫苗。
