Artemisinin resistance--modelling the potential human and economic costs.
Artemisinin resistance--modelling the potential human and economic costs.
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DOI：
10.1186/1475-2875-13-452
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发表时间：
2014-11-23
期刊：
影响因子：
3
通讯作者：
White LJ
中科院分区：
文献类型：
--
作者：
Lubell Y;Dondorp A;Guérin PJ;Drake T;Meek S;Ashley E;Day NP;White NJ;White LJ
在流行疟疾的世界，青蒿素联合疗法被推荐作为恶性疟疾的一线治疗方法，并且越来越多地依赖于治疗氯喹不起作用的间日疟疾。2007年在柬埔寨西部首次发现了青蒿素耐药性，现在在大湄公河地区得到证实，这引发了疟疾卷土重来的幽灵，可能使十年来在控制方面取得的进展毁于一旦，并威胁到消除疟疾的可行性。这种威胁的严重程度还没有被量化。这一分析比较了一旦以青蒿素为基础的治疗获得高覆盖率后发生的两种未来情景的健康和经济后果。在第一种情况下，青蒿素联合疗法在管理无并发症疟疾方面基本有效，重症疟疾用青蒿琥酯治疗，而在第二种情况下，联合疗法失败率为30%，重症疟疾的治疗恢复到奎宁。该模型应用于所有疟疾流行国家，利用它们对疟疾发病率、传播强度和国内生产总值的具体估计。该模型描述了反复诊断和重新治疗临床失败的直接医疗费用以及严重疟疾的住院费用。对于生产力损失，使用保守摩擦成本法，该方法假设对那些在失业人群中被取代之前不再从事经济活动的个人的经济影响有限。使用保守假设和参数估计，该模型预测，在普遍出现青蒿素耐药性的情况下，每年死亡人数将超过116 000人。预计用于治疗临床失败和管理严重疟疾的医疗费用每年将超过3 200万美元。每年因发病率和死亡率过高而造成的生产力损失估计为3.85亿美元，在此期间，以青蒿素为基础的联合疗法仍然作为一线治疗方法使用。青蒿素耐药性所造成的健康和经济威胁的这些“大致数字”使我们更有理由呼吁采取紧急行动，尽早发现耐药性的出现，并遏制其从湄公河地区已知地点向流行地区其他地方的传播。
Artemisinin combination therapy is recommended as first-line treatment for falciparum malaria across the endemic world and is increasingly relied upon for treating vivax malaria where chloroquine is failing. Artemisinin resistance was first detected in western Cambodia in 2007, and is now confirmed in the Greater Mekong region, raising the spectre of a malaria resurgence that could undo a decade of progress in control, and threaten the feasibility of elimination. The magnitude of this threat has not been quantified. This analysis compares the health and economic consequences of two future scenarios occurring once artemisinin-based treatments are available with high coverage. In the first scenario, artemisinin combination therapy (ACT) is largely effective in the management of uncomplicated malaria and severe malaria is treated with artesunate, while in the second scenario ACT are failing at a rate of 30%, and treatment of severe malaria reverts to quinine. The model is applied to all malaria-endemic countries using their specific estimates for malaria incidence, transmission intensity and GDP. The model describes the direct medical costs for repeated diagnosis and retreatment of clinical failures as well as admission costs for severe malaria. For productivity losses, the conservative friction costing method is used, which assumes a limited economic impact for individuals that are no longer economically active until they are replaced from the unemployment pool. Using conservative assumptions and parameter estimates, the model projects an excess of 116,000 deaths annually in the scenario of widespread artemisinin resistance. The predicted medical costs for retreatment of clinical failures and for management of severe malaria exceed US$32 million per year. Productivity losses resulting from excess morbidity and mortality were estimated at US$385 million for each year during which failing ACT remained in use as first-line treatment. These ‘ballpark’ figures for the magnitude of the health and economic threat posed by artemisinin resistance add weight to the call for urgent action to detect the emergence of resistance as early as possible and contain its spread from known locations in the Mekong region to elsewhere in the endemic world.
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影响因子：
15.8
作者：
Carrara VI;Lwin KM;Phyo AP;Ashley E;Wiladphaingern J;Sriprawat K;Rijken M;Boel M;McGready R;Proux S;Chu C;Singhasivanon P;White N;Nosten F
通讯作者：
Nosten F
DOI：
10.1073/pnas.1006113108
发表时间：
2011-01-04
影响因子：
11.1
作者：
Saralamba, Sompob;Pan-Ngum, Wirichada;White, Lisa J.
通讯作者：
White, Lisa J.
影响因子：
6.4
作者：
Sawa, Patrick;Shekalaghe, Seif A.;Bousema, Teun
通讯作者：
Bousema, Teun
影响因子：
3
作者：
Maude RJ;Pontavornpinyo W;Saralamba S;Aguas R;Yeung S;Dondorp AM;Day NP;White NJ;White LJ
通讯作者：
White LJ
影响因子：
3.3
作者：
Mulligan, JA;Mandike, R;Mills, A
通讯作者：
Mills, A