Global economic costs due to vivax malaria and the potential impact of its radical cure: A modelling study.
Global economic costs due to vivax malaria and the potential impact of its radical cure: A modelling study.
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DOI：
10.1371/journal.pmed.1003614
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发表时间：
2021-06
期刊：
影响因子：
15.8
通讯作者：
Lubell Y
中科院分区：
文献类型：
--
作者：
Devine A;Battle KE;Meagher N;Howes RE;Dini S;Gething PW;Simpson JA;Price RN;Lubell Y
2017年，亚洲、中美洲和南美洲以及非洲之角报告了约1400万例间日疟原虫疟疾病例。间日疟的临床负担很大程度上是由其形成休眠肝脏阶段（催眠虫）的能力驱动的，休眠肝脏阶段可以重新激活，导致疟疾的复发。需要消除血液和肝脏阶段的寄生虫（“根治”），以实现持续的临床反应，并防止寄生虫的持续传播。新的治疗选择和即时诊断现在可用于确保根治性治疗可以安全有效地管理。我们量化了间日疟的全球经济成本，并在对患者进行葡萄糖-6-磷酸脱氢酶（G6 PD）缺乏症检测后，估计了根治政策的潜在成本效益。对间日疟引起的医疗保健提供者和家庭成本的估计进行了整理，并与2017年44个流行国家的国家病例估计数相结合。将这些提供者和家庭成本与G6 PD筛查后根治的2种情况下发生的成本进行比较：（1）每日监督伯氨喹治疗后的完全依从性和（2）假设40%有效性的无监督治疗。概率敏感性分析产生的可信区间（CrIs）的估计。在全球范围内，间日疟的年度成本为3.59亿美元（95%CrI：2.22亿至5.63亿美元），这归因于2017年的1420万例间日疟病例。从社会的角度来看，对所有符合条件的患者采取G6 PD缺乏症筛查和伯氨喹监督的政策将预防610万例病例，并将全球间日疟成本降至2.66亿美元（95% CrI：1.61亿至4.15亿美元），尽管医疗保健提供者的成本将增加3900万美元。如果单次访视就能实现完全遵守，那么全球成本将进一步降至2.25亿美元，相当于从基线全球成本节省1.35亿美元。无监督伯氨喹政策将成本降低至3.42亿美元（95% CrI：2.09亿至5.32亿美元），同时预防了210万例病例。该研究的局限性包括国家级成本数据的部分可用性和处方伯氨喹的患者比例的参数不确定性，患者对伯氨喹全疗程的依从性，以及伯氨喹在无人监督时的有效性。我们的模拟研究强调了间日疟的巨大全球经济负担，可以通过投资于通过常规筛查G6 PD缺乏症和监督治疗实现的安全有效的根治来减少。新的，低成本的干预措施，以提高遵守伯氨喹，以确保有效的根治和广泛获得筛查G6 PD缺乏症将是至关重要的，以实现及时的全球消除间日疟原虫。迪瓦恩博士和合著者强调了间日疟的全球经济负担，可以通过对根治性治疗的投资来减轻。通过常规筛查G6 PD缺乏症和治疗监督，可以实现安全有效的治疗。间日疟是一种常见于亚洲、拉丁美洲和非洲之角的蚊媒发热性疾病。虽然是发病率高的一个原因，但其全球费用负担以前没有使用国家一级的数据进行过估计。要及时消灭间日疟，就必须广泛提供安全有效的根治办法。对间日疟的流行病学和医疗保健提供者和家庭的费用数据进行了整理，以得出间日疟的年度全球费用负担。广泛提供伯喹根治的潜在影响在44个流行国家的病例发生率和成本方面进行了量化。2017年，全球间日疟的成本为3.59亿美元，但通过筛查G6 PD缺乏症和提供有监督的高剂量伯氨喹，可以减少9360万美元。有监督的伯氨喹可以大幅降低家庭和全球间日疟成本，尽管医疗保健提供者的成本会更高。需要新的、低成本的方法来提高依从性，以确保根治的可负担性和规模化。
In 2017, an estimated 14 million cases of Plasmodium vivax malaria were reported from Asia, Central and South America, and the Horn of Africa. The clinical burden of vivax malaria is largely driven by its ability to form dormant liver stages (hypnozoites) that can reactivate to cause recurrent episodes of malaria. Elimination of both the blood and liver stages of the parasites (“radical cure”) is required to achieve a sustained clinical response and prevent ongoing transmission of the parasite. Novel treatment options and point-of-care diagnostics are now available to ensure that radical cure can be administered safely and effectively. We quantified the global economic cost of vivax malaria and estimated the potential cost benefit of a policy of radical cure after testing patients for glucose-6-phosphate dehydrogenase (G6PD) deficiency. Estimates of the healthcare provider and household costs due to vivax malaria were collated and combined with national case estimates for 44 endemic countries in 2017. These provider and household costs were compared with those that would be incurred under 2 scenarios for radical cure following G6PD screening: (1) complete adherence following daily supervised primaquine therapy and (2) unsupervised treatment with an assumed 40% effectiveness. A probabilistic sensitivity analysis generated credible intervals (CrIs) for the estimates. Globally, the annual cost of vivax malaria was US$359 million (95% CrI: US$222 to 563 million), attributable to 14.2 million cases of vivax malaria in 2017. From a societal perspective, adopting a policy of G6PD deficiency screening and supervision of primaquine to all eligible patients would prevent 6.1 million cases and reduce the global cost of vivax malaria to US$266 million (95% CrI: US$161 to 415 million), although healthcare provider costs would increase by US$39 million. If perfect adherence could be achieved with a single visit, then the global cost would fall further to US$225 million, equivalent to $135 million in cost savings from the baseline global costs. A policy of unsupervised primaquine reduced the cost to US$342 million (95% CrI: US$209 to 532 million) while preventing 2.1 million cases. Limitations of the study include partial availability of country-level cost data and parameter uncertainty for the proportion of patients prescribed primaquine, patient adherence to a full course of primaquine, and effectiveness of primaquine when unsupervised. Our modelling study highlights a substantial global economic burden of vivax malaria that could be reduced through investment in safe and effective radical cure achieved by routine screening for G6PD deficiency and supervision of treatment. Novel, low-cost interventions for improving adherence to primaquine to ensure effective radical cure and widespread access to screening for G6PD deficiency will be critical to achieving the timely global elimination of P. vivax. Dr. Devine and co-authors highlight the global economic burden of vivax malaria that could be reduced through investment in radical cure. Safe and effective cure could be achieved by routine screening for G6PD deficiency and treatment supervision. Vivax malaria is a mosquito-borne febrile illness common in Asia, Latin America, and the Horn of Africa. Although a cause of significant morbidity, its global cost burden has not previously been estimated using country-level data. The timely elimination of vivax malaria will require widespread access to safe and effective radical cure. Data on the epidemiology and costs of vivax malaria to healthcare providers and households were collated to derive the annual global cost burden of vivax malaria. The potential impact of widespread provision of primaquine radical cure was quantified in terms of case incidence and costs for 44 endemic countries. The global cost of vivax malaria in 2017 was US$359 million, but this could be reduced by US$93.6 million by screening for G6PD deficiency and provision of supervised high-dose primaquine. Supervised primaquine can lead to a substantial reduction in household and global costs of vivax malaria, although the costs to healthcare providers will be higher. Novel, low-cost methods for improving adherence are needed to ensure the affordability and scale-up of radical cure.
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影响因子：
3.8
作者：
Bôtto-Menezes C;Bardají A;Dos Santos Campos G;Fernandes S;Hanson K;Martínez-Espinosa FE;Menéndez C;Sicuri E
通讯作者：
Sicuri E
影响因子：
6.2
作者：
Bleakley, Hoyt
通讯作者：
Bleakley, Hoyt
DOI：
10.4269/ajtmh.2010.09-0521
发表时间：
2010-06-01
影响因子：
3.3
作者：
Grietens, Koen Peeters;Soto, Veronica;Gamboa, Dionicia
通讯作者：
Gamboa, Dionicia
影响因子：
3
作者：
Battle, Katherine E.;Cameron, Ewan;Hay, Simon I.
通讯作者：
Hay, Simon I.
DOI：
10.4269/ajtmh.16-0180
发表时间：
2016-12-28
期刊：
The American journal of tropical medicine and hygiene
影响因子：
--
作者：
Bassat Q;Velarde M;Mueller I;Lin J;Leslie T;Wongsrichanalai C;Baird JK
通讯作者：
Baird JK