Health economic impacts and cost-effectiveness of aflatoxin-reduction strategies in Africa: case studies in biocontrol and post-harvest interventions.
Health economic impacts and cost-effectiveness of aflatoxin-reduction strategies in Africa: case studies in biocontrol and post-harvest interventions.
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DOI：
10.1080/19440040903437865
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发表时间：
2010-04
期刊：
影响因子：
--
通讯作者：
Khlangwiset P
中科院分区：
文献类型：
--
作者：
Wu F;Khlangwiset P
事实证明，卫生经济学的进步有助于评估干预措施的成本效益，其好处通常表现为改善健康结果而不是市场结果。我们对非洲两种潜在的黄曲霉毒素控制策略进行了基于健康的成本效益分析：1）收获前生物防治，使用黄曲霉产毒菌株来竞争性地排除尼日利亚定植玉米中的产毒菌株；2）收获后一揽子干预措施，以减少几内亚花生中黄曲霉毒素的积累。我们描述了如何将每种干预措施所带来的健康益处（以减少黄曲霉毒素诱发的肝细胞癌（HCC）病例数）与实施干预措施的成本进行比较。我们发现，如果在非洲农业中广泛应用，这两种干预措施将极具成本效益。也就是说，通过减少黄曲霉毒素诱发的肝癌而挽救的生命和提高的生活质量的货币化价值远远超过了实现这些健康益处的生物防治或收获后干预方案的成本。尼日利亚玉米生物防治的估计成本效益比（CER；国内生产总值乘以每单位成本节省的伤残调整寿命年）为 5.10 至 24.8；几内亚花生采后干预方案的估计 CER 范围为 0.21 至 2.08。世界卫生组织认为任何 CER 大于 1 的干预措施都“非常具有成本效益”，而 CER 大于 0.33 的干预措施则被认为“具有成本效益”。除了成本效益之外，公共卫生干预措施还必须易于被公众接受，并且必须有财政和基础设施支持，以便在世界上最需要的地区可行。
Advances in health economics have proven useful in evaluating the cost-effectiveness of interventions, where the benefit usually takes the form of improved health outcomes rather than market outcomes. We perform health-based cost-effectiveness analyses of two potential aflatoxin control strategies in Africa: 1) pre-harvest biocontrol, using atoxigenic strains of Aspergillus flavus to competitively exclude toxigenic strains from colonizing maize in Nigeria, and 2) postharvest interventions in a package to reduce aflatoxin accumulation in groundnuts in Guinea. We describe how health benefits gained from each intervention, in terms of fewer aflatoxin-induced hepatocellular carcinoma (HCC) cases, can be compared with costs of implementing the interventions. We find that both interventions would be extremely cost-effective if applied widely in African agriculture. That is, the monetized value of lives saved and quality of life gained by reducing aflatoxin-induced HCC far exceeds the cost of either biocontrol or the postharvest intervention package to achieve those health benefits. The estimated cost-effectiveness ratio (CER; gross domestic product multiplied by disability-adjusted life years saved per unit cost) for biocontrol in Nigerian maize ranges from 5.10 to 24.8; while the estimated CER for the postharvest intervention package in Guinean groundnuts ranges from 0.21 to 2.08. Any intervention with a CER greater than 1 is considered by the World Health Organization to be “very cost-effective,” while an intervention with a CER greater than 0.33 is considered “cost-effective.” Aside from cost-effectiveness, public health interventions must be readily accepted by the public, and must have financial and infrastructural support to be feasible in the parts of the world where they are most needed.
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影响因子：
2.7
作者：
Hell, K;Cardwell, KF;Poehling, HM
通讯作者：
Poehling, HM
影响因子：
5
作者：
Ehrlich, KC;Cotty, PJ
通讯作者：
Cotty, PJ
DOI：
10.1590/s0036-46652008000400006
发表时间：
2008-08-01
期刊：
Revista do Instituto de Medicina Tropical de São Paulo
影响因子：
--
作者：
Forbi, J. C.;Onyemauwa, N.;Agwale, S. M.
通讯作者：
Agwale, S. M.
影响因子：
56.9
作者：
Henry, SH;Bosch, FX;Bolger, PM
通讯作者：
Bolger, PM
影响因子：
2
作者：
Dorner, JW;Cole, RJ;Wicklow, DT
通讯作者：
Wicklow, DT