Cost and cost-effectiveness of nationwide school-based helminth control in Uganda: intra-country variation and effects of scaling-up
Cost and cost-effectiveness of nationwide school-based helminth control in Uganda: intra-country variation and effects of scaling-up
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DOI：
10.1093/heapol/czm041
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发表时间：
2008-01-01
影响因子：
3.2
通讯作者：
Devlin, Nancy
中科院分区：
文献类型：
--
作者：
Brooker, Simon;Kabatereine, Narcis B.;Devlin, Nancy
成本和成本效益的估计通常基于数量有限的小规模研究，没有调查规模经济的存在或成本和成本效益的国家内部差异。这种信息差距阻碍了医疗保健资源的有效分配以及将估计结果推广到其他环境的能力。本研究调查了乌干达全国学校治疗蠕虫感染的成本和成本效益的国内差异。项目成本数据是通过对地区官员的半结构化访谈以及 23 个干预地区中 6 个地区的会计记录收集的。评估了财务和经济成本。成本是根据美国每名接受治疗的学童的成本估算的，并使用增量成本效益比（美国每例避免贫血的成本）来评估计划的成本效益。进行敏感性分析以评估折扣率和药品价格的影响。六个地区治疗每个儿童的总体经济成本为 0.54 美元，每避免贫血病例的成本效益为 3.19 美元。分析表明，成本和成本效益的估计与接受治疗的儿童总数存在显着差异，表明存在规模经济。各地区之间的每个治疗个体的费用（0.410.91 美元）和每个避免贫血病例的费用（1.709.51 美元）也存在很大差异。显示自变量与两组估计值在统计上相关。这项研究强调了在不了解观察到的变化的本质的情况下跨环境传输数据的潜在偏差。
Estimates of cost and cost-effectiveness are typically based on a limited number of small-scale studies with no investigation of the existence of economies to scale or intra-country variation in cost and cost-effectiveness. This information gap hinders the efficient allocation of health care resources and the ability to generalize estimates to other settings. The current study investigates the intra-country variation in the cost and cost-effectiveness of nationwide school-based treatment of helminth (worm) infection in Uganda. Programme cost data were collected through semi-structured interviews with district officials and from accounting records in six of the 23 intervention districts. Both financial and economic costs were assessed. Costs were estimated on the basis of cost in US per schoolchild treated, and an incremental cost-effectiveness ratio (cost in US per case of anaemia averted) was used to evaluate programme cost-effectiveness. Sensitivity analysis was performed to assess the effect of discount rate and drug price. The overall economic cost per child treated in the six districts was US0.54 and the cost-effectiveness was US$3.19 per case of anaemia averted. Analysis indicated that estimates of both cost and cost-effectiveness differ markedly with the total number of children who received treatment, indicating economies of scale. There was also substantial variation between districts in the cost per individual treated (US$0.410.91) and cost per anaemia case averted (US$1.709.51). Independent variables were shown to be statistically associated with both sets of estimates. This study highlights the potential bias in transferring data across settings without understanding the nature of observed variations.