Achieving the millennium development goals for health - Cost effectiveness analysis of strategies to combat HIV/AIDS in developing countries
Achieving the millennium development goals for health - Cost effectiveness analysis of strategies to combat HIV/AIDS in developing countries
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DOI：
10.1136/bmj.38643.368692.68
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发表时间：
2005-12-17
影响因子：
--
通讯作者：
Salomon, JA
中科院分区：
文献类型：
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作者：
Hogan, DR;Baltussen, R;Salomon, JA
目的评估在防治艾滋病毒/艾滋病的千年发展目标的背景下，为预防艾滋病毒传播和治疗艾滋病毒/艾滋病患者而采取的一系列干预措施的成本和健康影响。撒哈拉以南非洲国家的成人和儿童死亡率非常高，东南亚国家的成人和儿童死亡率也很高。数据来源生物和行为参数来自临床和观察性研究以及基于人口的调查。基于已发表的报告、专家意见和WHO-CHOICE数据库的干预效果和资源投入。主要结果测量以2000国际元（$Int）计算的每残疾调整生命年（DALY）的成本。结果在这两个地区，干预措施侧重于大众媒体、教育和女性性工作者性传播感染的治疗。在一般人群中，性传播感染的治疗费用每避免一个DALY <150美元。在这两个地区，自愿咨询和检测费用每DALY低于350美元，而预防母婴传播费用在Afr-E每DALY低于50美元，但在Sear-D每DALY约为850美元。以学校为基础的教育策略和各种抗逆转录病毒治疗策略的成本之间$Int500和$Int5000每DALY averted.Conclusions减少艾滋病毒的传播可以最有效地通过大众媒体宣传，性工作者的干预措施和治疗性传播感染的资源是最稀缺的。然而，预防母婴传播、自愿咨询和检测以及学校教育将在更高的预算水平上产生进一步的保健收益，并将根据标准国际基准被视为具有成本效益或高度成本效益。抗逆转录病毒疗法在改善人口健康方面至少与其中一些干预措施一样具有成本效益。
Objective To assess the costs and health effects of a range of interventions for preventing the spread of HIV and for treating people with HIV/AIDS in the context of the millennium development goal for combating HIV/AIDS.Design Cost effectiveness analysis based on an epidemiological model.Setting Analyses undertaken for two regions classified using the WHO epidemiological grouping-Afr-E, countries in sub-Saharan Africa with very high adult and high child mortality, and Sear-D, countries in South East Asia with high adult and high child mortality.Data sources Biological and behavioural parameters from clinical and observational studies and population based surveys. Intervention effects and resource inputs based on published reports, expert opinion, and the WHO-CHOICE database.Main outcome measures Costs per disability adjusted life year (DALY) averted in 2000 international dollars ($Int).Results In both regions interventions focused on mass media, education and treatment of sexually transmitted infections for female sex workers, amid treatment of sexually transmitted infections in the general population cost < $Int150 per DALY averted. Voluntary counselling and testing costs < $Int350 per DALY averted in both regions, while prevention of mother to child transmission costs < $Int50 per DALY averted in Afr-E but around $Int850 per DALY in Sear-D. School based education strategies and various antiretroviral treatment strategies cost between $Int500 and $Int5000 per DALY averted.Conclusions Reducing HIV transmission could be done most efficiently through mass media campaigns, interventions for sex workers and treatment of sexually transmitted infections where resources are most scarce. However, prevention of mother to child transmission, voluntary counselling and testing, and school based education would yield further health gains at higher budget levels and would be regarded as cost effective or highly cost effective based on standard international benchmarks. Antiretroviral therapy is at least as cost effective in improving population health as some of these interventions.