Modelling the cost-effectiveness of introducing the RTS,S malaria vaccine relative to scaling up other malaria interventions in sub-Saharan Africa.
Modelling the cost-effectiveness of introducing the RTS,S malaria vaccine relative to scaling up other malaria interventions in sub-Saharan Africa.
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DOI：
10.1136/bmjgh-2016-000090
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发表时间：
2017
影响因子：
8.1
通讯作者：
Ghani AC
中科院分区：
文献类型：
--
作者：
Winskill P;Walker PG;Griffin JT;Ghani AC
评估在撒哈拉以南非洲地区引入 RTS,S 疟疾疫苗与进一步扩大现有干预措施的相对成本效益。数学建模和成本效益研究。撒哈拉以南非洲。各个年龄段的人。该分析考虑了 RTS,S 疟疾疫苗的引进和扩大规模，以及长效杀虫剂处理蚊帐 (LLIN)、室内滞留喷洒 (IRS) 和季节性疟疾化学预防 (SMC) 的扩大。 10 年间所有年龄组避免的恶性疟原虫病例数。假设获得治疗的机会保持不变，那么增加 LLIN 的覆盖范围始终是一系列传播环境中最具成本效益的干预措施，并且被发现发生在成本效益扩大途径的早期。一旦 LLIN 覆盖范围最大化，IRS、RTS、S 和 SMC 就进入了具有成本效益的途径。如果包含非线性生产函数来捕获达到极高覆盖率的成本，则所得路径将变得更加复杂，并导致选择多种干预措施。 RTS,S 在成本效益途径中的实施始终晚于 LLIN、IRS 和 SMC，但在许多情况下作为第四种干预措施仍然具有价值，可以将负担减轻到国际目标中规定的水平。
To evaluate the relative cost-effectiveness of introducing the RTS,S malaria vaccine in sub-Saharan Africa compared with further scale-up of existing interventions. A mathematical modelling and cost-effectiveness study. Sub-Saharan Africa. People of all ages. The analysis considers the introduction and scale-up of the RTS,S malaria vaccine and the scale-up of long-lasting insecticide-treated bed nets (LLINs), indoor residual spraying (IRS) and seasonal malaria chemoprevention (SMC). The number of Plasmodium falciparum cases averted in all age groups over a 10-year period. Assuming access to treatment remains constant, increasing coverage of LLINs was consistently the most cost-effective intervention across a range of transmission settings and was found to occur early in the cost-effectiveness scale-up pathway. IRS, RTS,S and SMC entered the cost-effective pathway once LLIN coverage had been maximised. If non-linear production functions are included to capture the cost of reaching very high coverage, the resulting pathways become more complex and result in selection of multiple interventions. RTS,S was consistently implemented later in the cost-effectiveness pathway than the LLINs, IRS and SMC but was still of value as a fourth intervention in many settings to reduce burden to the levels set out in the international goals.