Using cost-effectiveness analysis to evaluate targeting strategies: The case of vitamin A supplementation
Using cost-effectiveness analysis to evaluate targeting strategies: The case of vitamin A supplementation
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DOI：
10.1093/heapol/12.1.29
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发表时间：
1997-03-01
影响因子：
3.2
通讯作者：
Costales, MO
中科院分区：
文献类型：
--
作者：
Loevinsohn, BP;Sutter, RW;Costales, MO
鉴于维生素 A 补充剂在降低儿童死亡率方面已得到证实的功效，卫生官员现在必须决定 ii: 将补充剂针对高危儿童是否有效。关于目标定位的决策很复杂，因为它们取决于许多因素；可预防死亡的聚集程度、干预措施的成本、干预措施的副作用、识别高风险群体的成本以及风险“诊断”的准确性。菲律宾进行了一项成本效益分析，以检验是否应向所有 6-59 个月的儿童普遍提供维生素 A 补充剂，广泛针对患有轻度、中度或重度营养不良的儿童，还是狭隘地针对中度和重度营养不良的学前儿童。通用方法第一年每避免死亡的平均成本为 67.21 美元，而广义和狭义目标方法的平均成本分别为 144.12 美元和 257.20 美元。当进行敏感性分析时，关于最具成本效益策略的结论对于补充剂功效、死亡聚集和毒性等基本假设的变化是稳健的。将维生素 A 补充剂针对高危儿童并不是一种有效的资源利用。根据成本效益分析的结果以及对替代策略的考虑，显然应该向发展中国家的所有学龄前儿童提供维生素 A，就像免疫接种一样。有关公共卫生干预措施目标的问题可以通过成本效益分析得到有效解决。
Given the demonstrated efficacy of vitamin A supplements in reducing childhoood mortality, health officials now have to decide whether ii: would be efficient to target the supplements to high risk children. Decisions about targeting are complex because they depend on a number of factors; the degree of clustering of preventable deaths, the cost of the intervention, the side-effects of the intervention, the cost of identifying the high risk group, and the accuracy of the 'diagnosis' of risk.A cost-effectiveness analysis was used in the Philippines to examine whether vitamin A supplements should be given universally to all children 6-59 months, targeted broadly to children suffering from mild, moderate, or severe malnutrition, or targeted narrowly to pre-schoolers with moderate and severe malnutrition. The first year average cost of the universal approach was US$67.21 per death averted compared to $144.12 and $257.20 for the broad and narrow targeting approaches respectively. When subjected to sensitivity analysis the conclusion about the most cost-effective strategy was robust to changes in underlying assumptions such as the efficacy of supplements, clustering of deaths, and toxicity.Targeting vitamin A supplements to high risk children is not an efficient use of resources. Based on the results of this cost-effectiveness analysis and a consideration of alternate strategies, it is apparent that vitamin A, like immunization, should be provided to all pre-schoolers in the developing world. Issues about targeting public health interventions can usefully be addressed by cost-effectiveness analysis.