Costs Associated with Malaria in Pregnancy in the Brazilian Amazon, a Low Endemic Area Where Plasmodium vivax Predominates.
Costs Associated with Malaria in Pregnancy in the Brazilian Amazon, a Low Endemic Area Where Plasmodium vivax Predominates.
复制标题
DOI：
10.1371/journal.pntd.0004494
复制
发表时间：
2016-03
影响因子：
3.8
通讯作者：
Sicuri E
中科院分区：
文献类型：
--
作者：
Bôtto-Menezes C;Bardají A;Dos Santos Campos G;Fernandes S;Hanson K;Martínez-Espinosa FE;Menéndez C;Sicuri E
到目前为止，关于间日疟原虫占主导地位的低传播区与妊娠期疟疾(MIP)相关费用的信息尚不清楚。这项研究估计了巴西亚马逊地区MIP的医疗系统和患者成本。2011年1月至2012年3月期间，通过在亚马逊州马瑙斯市区的一家三级转诊医院和一家初级保健中心进行的离职调查，收集了治疗MIP的病人费用。被诊断患有疟疾的孕妇和产后妇女在门诊会诊后或入院后出院时接受采访。分析中包括了73次访谈。96%的病例由间日疟原虫引起，4%由恶性疟原虫引起。2010年，从患者的角度来看，门诊和入院的总中位数成本估计分别为4591美元和216.29美元。当考虑到同一孕期间日疟原虫感染时，患者费用增加高达335.85美元，相当于一次入院和一次门诊会诊的费用。供应商直接成本和间接费用数据是从几个来源获得的。与一个门诊病例相关的提供者费用包括在三级医院的几次会诊，一个间日疟病例的费用为103.51美元，一个恶性疟疾病例的费用为83.59美元。住院一天的费用为118.51美元，平均住院3天的费用为355.53美元。2010年马瑙斯(N=364)孕妇报告的所有疟疾病例的诊断和治疗总费用为17,038.50美元，其中92.4%(15,741.14美元)是由间日疟原虫感染引起的。尽管MIP是疟疾低风险传播的地区，但它给马瑙斯造成了巨大的经济负担。尤其是当考虑到多重感染时，与间日疟原虫相关的成本比与恶性疟原虫相关的成本更高。所产生的信息可能有助于该地区当前控制和未来消除疟疾的卫生政策决策。妊娠期疟疾(MIP)与母婴发病率和死亡率有关。除临床负担外，MiP还意味着重大的经济负担，但关于MiP经济学的现有证据很少，仅限于恶性疟原虫疟疾和撒哈拉以南地区。虽然最近人们对间日疟原虫的流行病学和临床后果越来越感兴趣，但对间日疟原虫的经济学研究却被忽视了。间日疟原虫在拉丁美洲流行，巴西是美洲大陆报告间日疟原虫感染负担最高的国家。2011至2012年间，我们在巴西亚马逊的马瑙斯市进行了一项研究，目的是从医疗提供者和患者的角度估计与MIP相关的成本。尽管是一个低传播风险的地区，我们发现治疗MIP的成本是不可忽视的。特别是，从患者和提供者的角度来看，当需要入院时以及在同一怀孕期间随后发生间日疟的费用发生时，费用都经历了显著的增加。所产生的信息可能有助于该地区当前控制和未来消除疟疾的卫生政策决策。
Information on costs associated with malaria in pregnancy (MiP) in low transmission areas where Plasmodium vivax predominates is so far missing. This study estimates health system and patient costs of MiP in the Brazilian Amazon. Between January 2011 and March 2012 patient costs for the treatment of MiP were collected through an exit survey at a tertiary referral hospital and at a primary health care centre in the Manaus metropolitan area, Amazonas state. Pregnant and post-partum women diagnosed with malaria were interviewed after an outpatient consultation or at discharge after admission. Seventy-three interviews were included in the analysis. Ninety-six percent of episodes were due to P. vivax and 4% to Plasmodium falciparum. In 2010, the total median costs from the patient perspective were estimated at US $45.91 and US $216.29 for an outpatient consultation and an admission, respectively. When multiple P. vivax infections during the same pregnancy were considered, patient costs increased up to US $335.85, representing the costs of an admission plus an outpatient consultation. Provider direct and overhead cost data were obtained from several sources. The provider cost associated with an outpatient case, which includes several consultations at the tertiary hospital was US $103.51 for a P. vivax malaria episode and US $83.59 for a P. falciparum malaria episode. The cost of an inpatient day and average admission of 3 days was US $118.51 and US $355.53, respectively. Total provider costs for the diagnosis and treatment of all malaria cases reported in pregnant women in Manaus in 2010 (N = 364) were US $17,038.50, of which 92.4% (US$ 15,741.14) due to P. vivax infection. Despite being an area of low risk malaria transmission, MiP is responsible for a significant economic burden in Manaus. Especially when multiple infections are considered, costs associated with P. vivax are higher than costs associated with P. falciparum. The information generated may help health policy decisions for the current control and future elimination of malaria in the area. Malaria in pregnancy (MiP) is associated with maternal and foetal morbidity and mortality. In addition to the clinical burden, MiP implies a significant economic burden, but the little available evidence on the economics of MiP is limited to Plasmodium falciparum malaria and to the sub-Saharan region. While an increasing interest has been recently devoted to the epidemiology and the clinical consequences of Plasmodium vivax, the economics of P. vivax malaria is neglected. P. vivax is endemic in Latin America, and Brazil is the country with the highest reported burden of MiP of the American continent. Between 2011 and 2012, we conducted a study in the city of Manaus, Brazilian Amazon, with the aim of estimating costs associated with MiP both from the health provider and the patient perspectives. Despite being an area of low transmission risk, we found that the costs of treating MiP are not negligible. In particular, both from the patient and the provider perspectives, costs underwent a remarkable increase when admission was required and when the cost of subsequent P. vivax malaria episodes during the same pregnancy occurred. The information generated may help health policy decisions for the current control and future elimination of malaria in the area.