Evaluation of intensified dengue control measures with interrupted time series analysis in the Panadura Medical Officer of Health division in Sri Lanka: a case study and cost-effectiveness analysis
Evaluation of intensified dengue control measures with interrupted time series analysis in the Panadura Medical Officer of Health division in Sri Lanka: a case study and cost-effectiveness analysis
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DOI：
10.1016/s2542-5196(19)30057-9
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发表时间：
2019-05-01
影响因子：
25.7
通讯作者：
Tozan, Yesim
中科院分区：
文献类型：
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作者：
Liyanage, Prasad;Rocklov, Joacim;Tozan, Yesim
背景登革热已成为斯里兰卡的一个主要公共卫生问题，给该国带来了相当大的经济负担。作为回应，2014年6月，卫生部与军队和警察部队合作启动了一项积极主动的病媒控制计划，称为军民合作（CIMIC）计划，该计划针对高风险的卫生医务人员（MOH）部门。该国。评估人口水平干预措施的有效性和成本效益对于指导公共卫生规划和资源分配决策至关重要，特别是在资源有限的卫生保健环境中。方法使用具有非线性扩展的中断时间序列设计，我们评估了2014年6月22日至2016年12月29日在帕纳杜拉的病媒控制干预措施的影响，斯里兰卡西部省的一个高风险卫生部分部我们使用登革热通报和幼虫调查数据，使用两个单独的模型估计干预前后Breteau指数和登革热发病率的降低，并调整随时间变化的混杂变量（即降雨量，温度和海洋尼诺指数）。我们还从国家登革热控制单位的角度评估了在登革热病例不同住院程度的情况下CIMIC方案的成本和成本效益（低[25%]，中[50%]，和高[75%]）的每残疾调整生命年（DALY）的成本。（相对危险度降低0.43，95%CI 0.26 - 0.70）和登革热发病率（0.43，0.28 - 0.67），后者在干预开始后2个月变得突出。平均避免登革热病例数估计为2192例（95%CI 1741至2643），2016年CIMIC计划的总成本为271615美元。人员成本约占总成本的89%。在中等住院水平的基本情况下，CIMIC方案在最低（453美元）和最高（1686美元）成本效益阈值下节省成本的概率为70%，净节省20247美元（95% CI-57266至97790），避免176个DALY（133至226），导致每个DALY避免的成本为-98美元（-497至395）。这也适用于高住院水平的情况（避免的每DALY成本-512美元，95% CI-872至-115），但概率更高，为99%。在住院率低的情况下（每一伤残调整生命年的费用避免了690美元，143至1379美元），尽管CIMIC方案在最低限度上是成本效益低的，概率为77%，在最高阈值时，它具有99%的成本效益本研究表明，如果实施干预措施，受登革热影响的社区可以从病媒控制投资中受益各部门严格协调。通过这样做，有可能在地方性环境中减少登革热的疾病和经济负担。版权所有（C）2019作者。爱思唯尔有限公司出版
Background Dengue has become a major public health problem in Sri Lanka with a considerable economic burden. As a response, in June, 2014, the Ministry of Health initiated a proactive vector control programme in partnership with military and police forces, known as the Civil-Military Cooperation (CIMIC) programme, that was targeted at high-risk Medical Officer of Health (MOH) divisions in the country. Evaluating the effectiveness and cost-effectiveness of population-level interventions is essential to guide public health planning and resource allocation decisions, particularly in resource-limited health-care settings.Methods Using an interrupted time series design with a non-linear extension, we evaluated the impact of vector control interventions from June 22, 2014, to Dec 29, 2016, in Panadura, a high-risk MOH division in Western Province, Sri Lanka. We used dengue notification and larval survey data to estimate the reduction in Breteau index and dengue incidence before and after the intervention using two separate models, adjusting for time-varying confounding variables (ie, rainfall, temperature, and the Oceanic Nino Index). We also assessed the cost and cost-effectiveness of the CIMIC programme from the perspective of the National Dengue Control Unit under the scenarios of different levels of hospitalisation of dengue cases (low [25%], medium [50%], and high [75%]) in terms of cost per disabilityadjusted life-year averted (DALY).Findings Vector control interventions had a significant impact on combined Breteau index (relative risk reduction 0.43, 95% CI 0.26 to 0.70) and on dengue incidence (0.43, 0.28 to 0.67), the latter becoming prominent 2 months after the intervention onset. The mean number of averted dengue cases was estimated at 2192 (95% CI 1741 to 2643), and the total cost of the CIMIC programme at 2016 US$271 615. Personnel costs accounted for about 89% of the total cost. In the base-case scenario of moderate level of hospitalisation, the CIMIC programme was cost-saving with a probability of 70% under both the lowest ($453) and highest ($1686) cost-effectiveness thresholds, resulting in a net saving of $20 247 (95% CI -57 266 to 97 790) and averting 176 DALYs (133 to 226), leading to a cost of -$98 (-497 to 395) per DALY averted. This was also the case for the scenario with high hospitalisation levels (cost per DALY averted -$512, 95% CI -872 to -115) but with a higher probability of 99%. In the scenario with low hospitalisation levels (cost per DALY averted $690, 143 to 1379), although the CIMIC programme was cost-ineffective at the lowest threshold with a probability of 77%, it was cost-effective at the highest threshold with a probability of 99%.Interpretation This study suggests that communities affected by dengue can benefit from investments in vector control if interventions are implemented rigorously and coordinated well across sectors. By doing so, it is possible to reduce the disease and economic burden of dengue in endemic settings. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd.