Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: decision tree model.
Cost effectiveness of community-based therapeutic care for children with severe acute malnutrition in Zambia: decision tree model.
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DOI：
10.1186/1478-7547-7-2
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发表时间：
2009-01-15
期刊：
影响因子：
--
通讯作者：
Bachmann MO
中科院分区：
文献类型：
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作者：
Bachmann MO
在非洲和亚洲，患有严重急性营养不良的五岁以下儿童如果得不到有效治疗，死亡率很高。SAM的基于初级护理的治疗可以有良好的结果，但其成本效益在很大程度上是未知的。这项研究估计了赞比亚卢萨卡政府初级卫生保健中心对严重急性营养不良儿童进行社区治疗护理（CTC）与不进行护理相比的成本效益。一个决策树模型将气候技术中心的成本（以2008年国际美元计）和成果与假设的“无所事事”替代方案进行了比较。主要结局为1年内的死亡率和存活1年后的残疾调整生命年（Disability Adjusted Life Years，DAPs）。四氯化碳的成果和保健服务费用来自四氯化碳方案、当地保健服务和世界卫生组织（世卫组织）的单位费用估计数。什么都不做的结果是从已发表的非洲队列研究中估计出来的。进行了概率和确定性敏感性分析。每名儿童的CTC平均费用为203美元（95%置信区间（CI）为139 - 274美元），其中即食食疗食品（RUTF）费用为36%，保健中心就诊费用为13%，住院费用为17%，建立方案时的技术支持费用为34%。CTC治疗组和未治疗组1年内的预期死亡率分别为9.2%和20.8%（风险差异为11.5%（95% CI 0.4-23.0%））。每挽救一个生命，CTC花费1760美元（95% CI 592 - 10142美元），每获得一个DALY花费53美元（95% CI 18 - 306美元）。如果社会愿意为每增加一个DALY支付至少88美元，CTC至少有80%的可能具有成本效益。分析最敏感的假设死亡率没有治疗，周CTC每个孩子和购买RUTF的成本。与发展中国家的其他优先保健干预措施相比，在各种假设下，CTC的成本效益相对较高。
Children aged under five years with severe acute malnutrition (SAM) in Africa and Asia have high mortality rates without effective treatment. Primary care-based treatment of SAM can have good outcomes but its cost effectiveness is largely unknown. This study estimated the cost effectiveness of community-based therapeutic care (CTC) for children with severe acute malnutrition in government primary health care centres in Lusaka, Zambia, compared to no care. A decision tree model compared the costs (in year 2008 international dollars) and outcomes of CTC to a hypothetical 'do-nothing' alternative. The primary outcomes were mortality within one year, and disability adjusted life years (DALYs) after surviving one year. Outcomes and health service costs of CTC were obtained from the CTC programme, local health services and World Health Organization (WHO) estimates of unit costs. Outcomes of doing nothing were estimated from published African cohort studies. Probabilistic and deterministic sensitivity analyses were done. The mean cost of CTC per child was $203 (95% confidence interval (CI) $139–$274), of which ready to use therapeutic food (RUTF) cost 36%, health centre visits cost 13%, hospital admissions cost 17% and technical support while establishing the programme cost 34%. Expected death rates within one year of presentation were 9.2% with CTC and 20.8% with no treatment (risk difference 11.5% (95% CI 0.4–23.0%). CTC cost $1760 (95% CI $592–$10142) per life saved and $ 53 (95% CI $18–$306) per DALY gained. CTC was at least 80% likely to be cost effective if society was willing to pay at least $88 per DALY gained. Analyses were most sensitive to assumptions about mortality rates with no treatment, weeks of CTC per child and costs of purchasing RUTF. CTC is relatively cost effective compared to other priority health care interventions in developing countries, for a wide range of assumptions.