血吸虫病重度流行村两种化疗策略费用与效果的研究

Analysis of Cost-Effectiveness on Two Chemotherapy Schemes to Schistosomiasis in Hyperendemic Villages of Hunan Province

目的 探讨全民化疗和择群化疗降低重度日本血吸虫病流行村居民感染率和发病率的效果 ,比较其费用效果的优劣。 方法 在洞庭湖区抽取社会经济因素和人群感染率相近的 6个行政村 ,3个村全民化疗 ,3个村择群化疗 (有疫水史者 ) ,用Kato-Katz、询检、B超等方法考核效果并进行费用对比分析。 结果 化疗对降低重度流行区人群感染率、感染度 ,减轻人群血吸虫病症状、体征有非常明显的效果 ;疫水史和粪检阳性符合率平均为 2 0 6 1% ,粪检阳性疫水史漏查率平均为 4 0 6 % ;两种化疗策略的效果相近 ,择群化疗组费用略低于全民化疗组。 结论 疫水史人群占总人群 78%以上的血吸虫病重度流行区 ,择群化疗策略与全民化疗策略效果相近 ,但费用略低于全民化疗策略。

Objective To study the impacts of mass chemotherapy and selective treatment to those with history of infested water contact (selective chemotherapy) in reducing the prevalence and morbidity of schistosoma japonicum infection in hyperendemic villages of Hunan Province, and to analyze the cost-effectiveness of the two schemes. Methods Six villages with similar social and epidemiological condition were selected from the Dongting Lake region. Mass chemotherapy was implemented in three villages while selective chemotherapy in the other three. Kato-Katz stool examination, inquiry of medical history, ultrasonographic examination and cost data were used to evaluate the cost-effectiveness of the two schemes. Result Both chemotherapy schemes had a significant impact in reducing the prevalence、intensity of infection and morbidity in the population. The coincidence rate of those with history of endemic water contact and stool egg positives was 20 16%, and the missing rate of stool egg positives among those without history of infested water contact was 4 06%. The effectiveness of the two schemes is close, while the cost of selective chemotherapy is slightly lower than that of mass chemotherapy. Conclusion In the hyperendemic areas of schistosomiasis where 78% of the residents had history of water contact, the effectiveness of mass chemotherapy and selective chemotherapy to those with history of water contact is close, but the cost of the later selective chemotherapy is slightly lower.