Cost-effectiveness study of three antimalarial drug combinations in Tanzania
Cost-effectiveness study of three antimalarial drug combinations in Tanzania
复制标题
DOI：
10.1371/journal.pmed.0030373
复制
发表时间：
2006-10-01
期刊：
影响因子：
15.8
通讯作者：
Whitty, Christopher J. M.
中科院分区：
文献类型：
--
作者：
Wiseman, Virginia;Kim, Michelle;Whitty, Christopher J. M.
由于对传统单一疗法的耐药性水平不断上升，世界卫生组织（WHO）和其他国际组织建议疟疾流行国家转向联合疗法，最好是青蒿素类复方制剂（ACT）。成本是部署的主要障碍。这些新的combinations.Methods和调查结果的成本效益的实地试验的证据很少药物组合的经济评价是围绕一个随机有效性试验的组合推荐的世界卫生组织，用于治疗坦桑尼亚儿童与非严重的幻灯片证明疟疾。药物组合为：阿莫地喹（AQ）、AQ+磺胺嘧啶-乙胺嘧啶（AQ+SP）、AQ+青蒿琥酯（AQ+AS）和蒿甲醚-苯芴醇（AL）6剂方案。从节省资源和避免疟疾病例的角度衡量效力（根据第14天和第28天的寄生虫学失败率）。所有的成本提供者和患者及其家属进行了估计和不确定的变量进行单变量敏感性分析。将每种组合与单药治疗（AQ）进行比较的增量分析显示，从社会角度来看，AL在第14天最具成本效益。在第28天，AL和AQ+AS之间的差异可以忽略不计;两者均导致每例病例避免的总节省约1.70美元或净节省22.40美元。改变诊断的准确性和用于评估无偿工作的最低工资率对避免的病例数和项目成本分别有显著影响，但这并没有改变AL和AQ+AS占主导地位的发现。结论在高耐药地区，有证据表明AL和AQ+AS是最具成本效益的药物，尽管是最昂贵的，因为它们比其他选择更有效，因此减少了进一步治疗的需要。在非洲部分地区，情况不一定如此，因为在这些地区，经SP和AQ治疗（及其组合）后复发率较低，因此青蒿素综合疗法的相对优势较小，或者诊断服务不准确，因此大部分药物流向未患疟疾的人。
Background As a result of rising levels of drug resistance to conventional monotherapy, the World Health Organization (WHO) and other international organisations have recommended that malaria endemic countries move to combination therapy, ideally with artemisinin-based combinations (ACTs). Cost is a major barrier to deployment. There is little evidence from field trials on the cost-effectiveness of these new combinations.Methods and Findings An economic evaluation of drug combinations was designed around a randomised effectiveness trial of combinations recommended by the WHO, used to treat Tanzanian children with non-severe slide-proven malaria. Drug combinations were: amodiaquine (AQ), AQ with sulfadoxine-pyrimethamine (AQ+SP), AQ with artesunate (AQ+AS), and artemether-lumefantrine (AL) in a six-dose regimen. Effectiveness was measured in terms of resource savings and cases of malaria averted (based on parasitological failure rates at days 14 and 28). All costs to providers and to patients and their families were estimated and uncertain variables were subjected to univariate sensitivity analysis. Incremental analysis comparing each combination to monotherapy (AQ) revealed that from a societal perspective AL was most cost-effective at day 14. At day 28 the difference between AL and AQ+AS was negligible; both resulted in a gross savings of approximately US$1.70 or a net saving of US$22.40 per case averted. Varying the accuracy of diagnosis and the subsistence wage rate used to value unpaid work had a significant effect on the number of cases averted and on programme costs, respectively, but this did not change the finding that AL and AQ+AS dominate monotherapy.Conclusions In an area of high drug resistance, there is evidence that AL and AQ+AS are the most cost-effective drugs despite being the most expensive, because they are significantly more effective than other options and therefore reduce the need for further treatment. This is not necessarily the case in parts of Africa where recrudescence following SP and AQ treatment (and their combination) is lower so that the relative advantage of ACTs is smaller, or where diagnostic services are not accurate and as a result much of the drug goes to those who do not have malaria.