Cost-effective malaria control in Brazil - Cost-effectiveness of a Malaria Control Program in the Amazon Basin of Brazil, 1988-1996
Cost-effective malaria control in Brazil - Cost-effectiveness of a Malaria Control Program in the Amazon Basin of Brazil, 1988-1996
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DOI：
10.1016/s0277-9536(99)00214-2
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发表时间：
1999-11-01
影响因子：
5.4
通讯作者：
Gusmao, RD
中科院分区：
文献类型：
--
作者：
Akhavan, D;Musgrove, P;Gusmao, RD
到1980年，巴西其他地方的疟疾传播得到控制，但在亚马逊盆地，疟疾病例一直持续增加，直到1989年，每年几乎有50万例，死亡率在1977-1988年期间翻了两番。政府的疟疾控制计划在1987-1989年几乎在财政上崩溃，并在1991-1993年经历了动荡的重组。世界银行的一个项目从1989年底至1996年中期支持该方案，1992-1993年，在泛美卫生组织的帮助下，促进了向更早和更积极的病例治疗和更集中的病媒控制的转变。这一流行病在1990-1991年停止蔓延，并在1992-1996年逆转。从1989年到1996年年中，该方案的总费用为6.16亿美元：5.26亿美元用于预防，9，000万美元用于治疗。与没有该计划的情况相比，近200万例疟疾病例和231，000例死亡得以预防：挽救的生命几乎同样归功于预防感染和病例治疗。将节省的生命和发病率转换为残疾调整寿命年，可产生近900万丹麦克朗，其中510万来自治疗，390万来自预防。几乎所有的收益都来自控制死亡，因此也来自控制恶性疟原虫。总体成本效益为每挽救一条生命2，672美元或每DALY 69美元，与大多数以前的估计相比较低，与许多其他疾病控制干预措施相比有利，与以前的经验相反，病例治疗似乎比病媒控制更具成本效益，特别是在恶性疟原虫流行和无重点杀虫剂喷洒相对无效的地方，通过更有针对性的病媒控制和强调治疗来遏制这一流行病，大大降低了疟疾死亡率，大大降低了挽救每个生命的成本。(C)1999爱思唯尔科技有限公司。保留所有权利。
Malaria transmission was controlled elsewhere in Brazil by 1980, but in the Amazon Basin cases increased steadily until 1989, to almost half a million a year and the coefficient of mortality quadrupled in 1977-1988. The government's malaria control program almost collapsed financially in 1987-1989 and underwent a turbulent reorganization in 1991-1993. A World Bank project supported the program from late 1989 to mid-1996, and in 1992-1993, with help from the Pan American Health Organization, facilitated a change toward earlier and more aggressive case treatment and more concentrated vector control. The epidemic stopped expanding in 1990-1991 and reversed in 1992-1996. The total cost of the program from 1989 through mid-1996 was US$616 million: US$526 million for prevention and US$90 million for treatment. Compared to what would have happened in the absence of the program, nearly two million cases of malaria and 231,000 deaths were prevented: the lives saved were due almost equally to preventing infection and to case treatment. Converting the savings in lives and in morbidity into Disability-Adjusted Life Years yields almost nine million DALYs, 5.1 million from treatment and 3.9 million from prevention. Nearly all the gain came from controlling deaths and therefore from controlling falciparum. The overall cost-effectiveness was US$2672 per life saved or US$69 per DALY, which is low compared to most previous estimates and compares favorably to many other disease control interventions, Contrary to much previous experience, case treatment appears more cost-effective than vector control, particularly where falciparum is prevalent and unfocussed insecticide spraying is relatively ineffective, Halting the epidemic by better targeted vector control and emphasizing treatment paid off in much reduced mortality from malaria and in significantly lower costs per life saved. (C) 1999 Elsevier Science Ltd. All rights reserved.