Effectiveness and cost-effectiveness of reactive, targeted indoor residual spraying for malaria control in low-transmission settings: a cluster-randomised, non-inferiority trial in South Africa.
Effectiveness and cost-effectiveness of reactive, targeted indoor residual spraying for malaria control in low-transmission settings: a cluster-randomised, non-inferiority trial in South Africa.
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DOI：
10.1016/s0140-6736(21)00251-8
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发表时间：
2021-02-27
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影响因子：
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通讯作者：
Kleinschmidt I
中科院分区：
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作者：
Bath D;Cook J;Govere J;Mathebula P;Morris N;Hlongwana K;Raman J;Seocharan I;Zitha A;Zitha M;Mabuza A;Mbokazi F;Machaba E;Mabunda E;Jamesboy E;Biggs J;Drakeley C;Moonasar D;Maharaj R;Coetzee M;Pitt C;Kleinschmidt I
不断增加的杀虫剂成本和有限的疟疾预算可能会使室内滞留喷洒（IRS）等通用病媒控制策略在低传播环境中变得不可持续。我们研究了反应性、有针对性的 IRS 策略的有效性和成本效益。这项整群随机、开放标签、非劣效性试验将南非东北部两个疟疾季节（2015-17）的反应性、针对性 IRS 与标准 IRS 实践进行了比较。在标准的国税局集群中，项目经理每年进行大规模喷洒活动，利用历史数据、专家意见和其他因素对区域进行优先排序。在国税局目标集群中，只有指示病例的房屋（通过被动监测发现）及其紧邻的房屋才被喷洒。非劣效裕度为每 1000 人年 1 例。现实世界实施的卫生服务成本是根据第一手和第二手数据进行建模的。估算了每个伤残调整生命年（DALY）的增量成本，并进行了确定性和概率敏感性分析。本研究已在 ClinicalTrials.gov 注册，NCT02556242。标准 IRS 组中的疟疾发病率为每 1000 人年 0·95 例（95% CI 0·58 至 1·32），目标 IRS 组中的疟疾发病率为每 1000 人年 1·05 例（0·72 至 1·38），对应于每 1000 人年 0·10 例（–0·38 至 0·59）的比率差异，表明目标 IRS 的非劣效性 (p<0·0001)。每增加 DALY，目标国税局可节省 7845 美元（从 2902 美元到 64 907 美元），相对于南非合理的成本效益阈值（每避免 DALY 为 2637 美元到 3557 美元），转向目标国税局的可能性为 94–98%。根据所使用的阈值，目标 IRS 在每 1000 人年的发病率低于 2·0–2·7 时仍然具有成本效益。研究结果对于其他参数的合理变化是稳健的。在这种传播率极低的环境中，与标准 IRS 相比，定向 IRS 不逊色、安全、成本更低且具有成本效益。节省下来的资源可以重新分配给其他疟疾控制和消除活动。全球联合健康试验。
Increasing insecticide costs and constrained malaria budgets could make universal vector control strategies, such as indoor residual spraying (IRS), unsustainable in low-transmission settings. We investigated the effectiveness and cost-effectiveness of a reactive, targeted IRS strategy. This cluster-randomised, open-label, non-inferiority trial compared reactive, targeted IRS with standard IRS practice in northeastern South Africa over two malaria seasons (2015–17). In standard IRS clusters, programme managers conducted annual mass spray campaigns prioritising areas using historical data, expert opinion, and other factors. In targeted IRS clusters, only houses of index cases (identified through passive surveillance) and their immediate neighbours were sprayed. The non-inferiority margin was 1 case per 1000 person-years. Health service costs of real-world implementation were modelled from primary and secondary data. Incremental costs per disability-adjusted life-year (DALY) were estimated and deterministic and probabilistic sensitivity analyses conducted. This study is registered with ClinicalTrials.gov, NCT02556242. Malaria incidence was 0·95 per 1000 person-years (95% CI 0·58 to 1·32) in the standard IRS group and 1·05 per 1000 person-years (0·72 to 1·38) in the targeted IRS group, corresponding to a rate difference of 0·10 per 1000 person-years (–0·38 to 0·59), demonstrating non-inferiority for targeted IRS (p<0·0001). Per additional DALY incurred, targeted IRS saved US$7845 (2902 to 64 907), giving a 94–98% probability that switching to targeted IRS would be cost-effective relative to plausible cost-effectiveness thresholds for South Africa ($2637 to $3557 per DALY averted). Depending on the threshold used, targeted IRS would remain cost-effective at incidences of less than 2·0–2·7 per 1000 person-years. Findings were robust to plausible variation in other parameters. Targeted IRS was non-inferior, safe, less costly, and cost-effective compared with standard IRS in this very-low-transmission setting. Saved resources could be reallocated to other malaria control and elimination activities. Joint Global Health Trials.