Migliori G B, Khomenko A G, Punga V V, Ambrosetti M, Danilova I, Ribka L N, Grzemska M, Sawert H, Raviglione M C
Fondazione Salvatore Maugeri, Care and Research Institute, Tradate, Italy.
Bull World Health Organ. 1998;76(5):475-83.
Many of the current tuberculosis control programmes in the Russian Federation are based on costly strategies which are underfunded and use long, individualized treatment regimens. This article compares, using a cost-effectiveness analysis, the new WHO strategy implemented in the Ivanovo Oblast (case-finding among symptomatic patients (SCF) and shorter regimens) and the old strategy (active screening of the asymptomatic population (ACF) and longer regimens). The cost per case cured was calculated at different levels of cure rate (45-95%) using three scenarios to describe the new WHO strategy (use of WHO-recommended regimens and three options at increasing rates of admission) and a fourth scenario to describe the old strategy (all patients admitted for the whole treatment and longer regimens). The cost per case detected was determined by calculating the following: yield of the new and old strategy (number of examinations necessary to diagnose one case); cost of the diagnostic process; multiplying yield per cost according to the three scenarios describing the new WHO strategy and a fourth scenario describing the old strategy. In the Ivanovo Oblast the cost per case cured, at 85% cure rate level, ranged from US$ 1197 (new strategy, scenario 1 without food) to US$ 6293 (old strategy, scenario 4) the cost per case detected ranged from US$ 1581 (new strategy, scenario 1) to US$ 4000 (old strategy, scenario 4). Significant savings can result from shifting towards the new WHO strategy. Decision-makers and health administrators should be responsible for re-investing the financial and human resources mobilized by the adoption of cost-effective strategies within the TB control programme.
俄罗斯联邦目前的许多结核病控制项目都基于成本高昂的策略，这些策略资金不足，且采用长期、个体化的治疗方案。本文采用成本效益分析方法，比较了在伊万诺沃州实施的世卫组织新策略（对有症状患者进行病例发现（SCF）和采用较短治疗方案）和旧策略（对无症状人群进行主动筛查（ACF）和采用较长治疗方案）。使用三种情景来描述世卫组织新策略（采用世卫组织推荐的治疗方案以及三种不同入院率的选择）和一种情景来描述旧策略（所有患者接受全程治疗且采用较长治疗方案），计算了在不同治愈率水平（45%-95%）下每治愈一例的成本。通过计算以下内容确定每例检测成本：新旧策略的检出率（诊断一例所需的检查次数）；诊断过程的成本；根据描述世卫组织新策略的三种情景和描述旧策略的一种情景，将检出率乘以成本。在伊万诺沃州，治愈率为85%时，每治愈一例的成本从1197美元（新策略，情景1，无食物）到6293美元（旧策略，情景4）不等，每例检测成本从1581美元（新策略，情景1）到4000美元（旧策略，情景4）不等。转向世卫组织新策略可带来显著节省。决策者和卫生管理人员应负责将通过采用具有成本效益的策略在结核病控制项目中筹集的资金和人力资源进行再投资。
