Comparative impact assessment of child pneumonia interventions
Comparative impact assessment of child pneumonia interventions
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DOI：
10.2471/blt.08.050872
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发表时间：
2009-06-01
期刊：
影响因子：
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通讯作者：
Ezzati, Majid
中科院分区：
文献类型：
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作者：
Niessen, Louis;Hove, Anne ten;Ezzati, Majid
目的比较通过降低风险、免疫接种和病例管理等措施降低肺炎死亡率的成本效果。方法采用WHO提供的国别肺炎负担估计值和干预费用，评估5岁以下儿童肺炎风险估计值和干预措施的效果（病例管理、肺炎相关疫苗、改善营养和减少家庭固体燃料造成的室内空气污染）。我们计算了健康福利（残疾调整生命年，DALLS，避免）和干预费用在一段时间内。10年的40个国家，占90%的肺炎儿童deaths.Findings固体燃料的使用贡献30%（90%置信区间：18-44）的负担，儿童肺炎。有效的社区治疗、促进纯母乳喂养、补锌和B型流感嗜血杆菌（HiB）和肺炎链球菌免疫接种等现有方案的成本效益比在低收入国家为每DALY 10-60美元，在中等收入国家为每DALY不到120美元。低排放生物质炉灶和清洁燃料在低收入地区可能具有成本效益。基于设施的治疗可能具有成本效益，比率为每DALY 60-120伊元。社区病例管理的成本效益取决于家访成本。有效的病例管理、促进母乳喂养和补锌在降低肺炎死亡率方面具有成本效益。环境和营养干预措施可减少肺炎并提供其他益处。这些策略结合起来可以将儿童总死亡率降低17%。
Objective To-compare the cost-effectiveness of interventions to reduce pneumonia mortality through risk reduction, immunization and case management.Methods Country-specific pneumonia burden estimates and intervention costs from WHO were used to review estimates of pneumonia risk in children under 5 years of age and the efficacy of interventions (case management, pneumonia-related vaccines, improved nutrition and reduced indoor air pollution from household solid fuels). We calculated health benefits (disability-adjusted life years, DALYs, averted) and intervention costs over a period of. 10 years for 40 countries, accounting for 90% of pneumonia child deaths.Findings Solid fuel use contributes 30% (90% confidence interval: 18-44) to the burden of childhood pneumonia. Efficacious community-based treatment, promotion of exclusive breastfeeding, zinc supplementation and Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae immunization through existing programmes showed cost-effectiveness ratios of 10-60 International dollars (I$) per DALY in low-income countries and less than I$ 120 per DALY in middle-income countries. Low-emission biomass stoves and cleaner fuels may be cost-effective in low-income regions. Facility-based treatment is potentially cost-effective, with ratios of I$ 60-120 per DALY. The cost-effectiveness of community case management depends on home visit cost.Conclusion Vaccines against Hib and S. pneumoniae, efficacious case management, breastfeeding promotion and zinc supplementation are cost-effective in reducing pneumonia mortality. Environmental and nutritional interventions reduce pneumonia and provide other benefits. These strategies combined may reduce total child mortality by 17%.