Large-scale delivery of seasonal malaria chemoprevention to children under 10 in Senegal: an economic analysis
Large-scale delivery of seasonal malaria chemoprevention to children under 10 in Senegal: an economic analysis
复制标题
DOI：
10.1093/heapol/czx084
复制
发表时间：
2017-11-01
影响因子：
3.2
通讯作者：
Milligan, Paul J.
中科院分区：
文献类型：
--
作者：
Pitt, Catherine;Ndiaye, Mouhamed;Milligan, Paul J.
建议萨赫勒和萨赫勒地区 5 岁以下儿童进行季节性疟疾化学预防 (SMC)。较大儿童的负担可能证明扩大年龄范围是合理的，塞内加尔已经有效地做到了这一点。我们研究了社区卫生工作者 (CHW) 为 10 岁以下儿童上门提供 SMC 的费用。我们从卫生服务的角度分析了地区级及以下增量财务和经济成本。我们检查了项目账目，并通过提前引入调查问卷并在每个月实施后完成问卷的方式，前瞻性地收集了 405 个社区卫生工作者、46 个卫生站和 4 个区总部的数据。通过将 SMC 的财务成本与相关现有卫生支出水平进行比较，探讨了可负担性。费用按管理月份和卫生服务水平进行分类。我们使用线性回归模型来确定与卫生站之间的成本差异相关的因素。在一个疟疾季节向 180 000 名儿童提供 SMC 的财务费用为 234 549 美元（2010 年不变），即每月管理课程 0.50 美元，相当于 93% 的儿童接受了所有三项预期的 SMC 课程。不包括研究参与激励措施，该地区每名居民（所有年龄段）的财务成本为 0.32 美元，占塞内加尔政府人均卫生支出的 1.2%。经济成本比财务成本高出 18.7%，为 278 922 美元或每个课程 0.59 美元，并且不同卫生站之间差异很大，从每个课程 0.38 美元到 2.74 美元不等。各个卫生站都存在巨大的规模经济，最小的卫生站每月管理课程的平均成本最高。 10 岁以下儿童的 SMC 可能是负担得起的，特别是在它可以避免大量治疗费用的情况下。对其他情况下 SMC 的可能成本和成本效益的估计必须考虑到不同分娩月份和卫生站的平均成本的变化。
Seasonal Malaria Chemoprevention (SMC) is recommended for children under 5 in the Sahel and sub-Sahel. The burden in older children may justify extending the age range, as has been done effectively in Senegal. We examine costs of door-to-door SMC delivery to children up to 10 years by community health workers (CHWs). We analysed incremental financial and economic costs at district level and below from a health service perspective. We examined project accounts and prospectively collected data from 405 CHWs, 46 health posts, and 4 district headquarters by introducing questionnaires in advance and completing them after each monthly implementation round. Affordability was explored by comparing financial costs of SMC to relevant existing health expenditure levels. Costs were disaggregated by administration month and by health service level. We used linear regression models to identify factors associated with cost variation between health posts. The financial cost to administer SMC to 180 000 children over one malaria season, reaching similar to 93% of children with all three intended courses of SMC was $234 549 (constant 2010 USD) or $0.50 per monthly course administered. Excluding research-participation incentives, the financial cost was $0.32 per resident (all ages) in the catchment area, which is 1.2% of Senegal's general government expenditure on health per capita. Economic costs were 18.7% higher than financial costs at $278 922 or $0.59 per course administered and varied widely between health posts, from $0.38 to $2.74 per course administered. Substantial economies of scale across health posts were found, with the smallest health posts incurring highest average costs per monthly course administered. SMC for children up to 10 is likely to be affordable, particularly where it averts substantial curative care costs. Estimates of likely costs and cost-effectiveness of SMC in other contexts must account for variation in average costs across delivery months and health posts.