Cost-effectiveness of scaling up mass drug administration for the control of soil-transmitted helminths: a comparison of cost function and constant costs analyses
Cost-effectiveness of scaling up mass drug administration for the control of soil-transmitted helminths: a comparison of cost function and constant costs analyses
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DOI：
10.1016/s1473-3099(15)00268-6
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发表时间：
2016-07-01
影响因子：
56.3
通讯作者：
Anderson, Roy M.
中科院分区：
文献类型：
--
作者：
Turner, Hugo C.;Truscott, James E.;Anderson, Roy M.
背景为实现世卫组织2020年的目标，需要迅速扩大针对土壤传播蠕虫等被忽视热带疾病的大规模药物管理（MDA）的覆盖范围。我们的目的是比较使用的成本函数，以考虑到规模经济的标准方法，假设一个恒定的成本，每次治疗时，调查的成本和成本效益扩大STH MDA计划针对蛔虫。方法我们拟合的成本函数，描述如何MDA的成本变化与规模的经验成本数据，并将其纳入STH传输模型。使用这个成本函数，我们调查的后果，考虑到规模经济的预测成本效益的STH控制，通过与标准的方法，假设一个恒定的成本，每次治疗。成本函数拟合经济成本数据收集的一部分，在乌干达学校为基础的驱虫方案使用最大似然法。我们使用该模型来研究总体蠕虫负担的总体减少、避免的流行感染病例年总数和避免的重度感染病例年总数。对于每一年，我们计算的有效性之间的差异蠕虫负担或病例数和数量在没有treatment.Findings使用的成本函数时，STH控制的成本效益显着增加，该计划的规模扩大。相比之下，标准方法（每次治疗的固定成本）低估了这一点并产生了误导性的结论。例如，当将预测地区的控制从10%扩大到75%的高危学龄儿童覆盖率时，使用成本函数时，预防重负担感染的成本效益预计将增加70%以上，但下降了18%解释目前在大多数经济分析中，规模经济被排除在外，如果最大的成本-将制定有效的政策，控制被忽视的热带疾病。这些发现也与其他大规模疾病干预措施有关。版权所有（C）特纳等人。开放获取文章根据CC BY-NC-ND的条款分发。
Background The coverage of mass drug administration (MDA) for neglected tropical diseases, such as the soil-transmitted helminths (STHs), needs to rapidly expand to meet WHO's 2020 targets. We aimed to compare use of a cost function to take into account economies of scale to the standard method of assuming a constant cost per treatment when investigating the cost and cost-effectiveness of scaling up a STH MDA programme targeting Ascaris lumbricoides.Methods We fitted a cost function describing how the costs of MDA change with scale to empirical cost data and incorporated it into a STH transmission model. Using this cost function, we investigated the consequences of taking into account economies of scale on the projected cost-effectiveness of STH control, by comparison with the standard method of assuming a constant cost per treatment. The cost function was fitted to economic cost data collected as part of a school-based deworming programme in Uganda using maximum likelihood methods. We used the model to investigate the total reduction in the overall worm burden, the total number of prevalent infection case-years averted, and the total number of heavy infection case-years averted. For each year, we calculated the effectiveness as the difference between the worm burden or number of cases and the number in absence of treatment.Findings When using the cost function, the cost-effectiveness of STH control markedly increased as the programme was scaled up. By contrast, the standard method (constant cost per treatment) undervalued this and generated misleading conclusions. For example, when scaling up control in the projected district from 10% to 75% coverage of at-risk school-age children, the cost-effectiveness in terms of prevention of heavy burden infections was projected to increase by over 70% when using the cost function, but decrease by 18% when assuming a constant cost per treatment.Interpretation The current exclusion of economies of scale in most economic analyses must be addressed if the most cost-effective policies for the control of neglected tropical diseases are to be formulated. These findings are also relevant to other large-scale disease interventions. Copyright (C) Turner et al. Open Access article distributed under the terms of CC BY-NC-ND.