云南省元江流域现行疟疾预防措施的成本效果分析

Cost-effectiveness Analysis of the Current Measures for Malaria Prevention in Yuanjiang Valley, Yunnan Province

目的 评价现行疟疾预防措施在元江流域的成本效果。 方法 通过 3个现场干预试验和经济学分析 ,评价预防服药、单一 DDT滞留喷洒和两者综合使用的防疟作用和成本效果。 结果 1对筑路民工每月 1次的哌喹 /磺胺多辛预防服药 ,相对发病率指数为 0 .35 (95 % CI:0 .2 0～ 0 .5 9) ,7～ 11月保护 1人的费用为 6 .6 9元 ,减少 1例疟疾患者的费用为 4 5 9元。 2在河谷高疟村寨 ,10 d1次的氯喹加伯氨喹预防服药 ,相对发病率指数为 0 .2 8(95 % CI:0 .0 8～ 0 .99) ,5个月保护 1人的费用为 5 .30元 ,减少 1例疟疾患者的费用为 30 0元。 3在 5～ 9月 ,1月 1次的乙胺嘧啶/磺胺多辛预防服药组、 4月份 1次的 DDT滞留喷洒组、以及综合使用组的标准发病指数 (SMR)分别为 10 0 %、98%和5 0 % ;保护 1人的费用分别为 1.4 9、2 .4 8和 3.97元 ;单一预防服药组疟疾病例数 ,未能在上一年基础上继续减少 ,DDT滞留喷洒组和综合措施组减少 1例疟疾患者的费用分别为 14 5 35元和 90 8元。 结论 每月 1次的哌喹 /磺胺多辛和 10 d 1次的氯喹加伯氨喹预防服药成本差异不大。每月 1次的哌喹 /磺胺多辛在该地区的效果得到进一步证实。与单一措施相比较 ,综合性措施成本效果最佳 ,但费用昂贵。

Objective To evaluate the cost-effectiveness analysis of the measures currently used for malaria prevention in the region of Yuanjiang River Valley. . Methods. The efficacy and cost-effectiveness analysis of chemoprophylaxis, single DDT residual spraying and a combination of both were evaluated through three field intervention trials. Results . (1) From July to November, the rate ratio of malaria incidence among building workers of expressway as the group of chemoprophylaxis using combined piperaquine/sulfadoxine once per month was 0.^35 (95%CI: 0.^20-0.^59); the cost per individual protected (CIP) and the cost per case averted (CCA) were RMB 6.^69 yuan and RMB 459 yuan respectively. (2) In the hyper-endemic villages near the river, the rate ratio in the group using chloroquine plus primaquine once every 10 days for 5 months was 0.^28 (95%CI: 0.^08-0.^99); the CIP and CCA were RMB 5.^30 yuan and RMB 300 yuan respectively. (3) The standardized morbidity ratio (SMR) was 100%, 98% and 50% respectively for the chemoprophylaxis group with pyrimethamine/sulfadoxine once per month from May to September, the group with single DDT residual spraying in April and the group of combined chemoprophylaxis and DDT spraying. The CIP was RMB 1.^49, 2.^48 and 3.^97 yuan for the three groups respectively. As compared with the previous year, no cases were averted from the chemoprophlaxis group; the CCA was RMB 14 535 yuan and 908 yuan respectively for the DDT spraying group and the group with combined measures. . Conclusion . There was no significant difference on the chemoprophylaxis cost between the group using piperaquine/sulfadoxine combination once per month and that of chloroquine plus primaquine once per ten days. However, the study proved an efficacy for malaria prevention in the former but not in the latter. In comparison with the groups of single measures, the group with combined measures showed the best efficacy and effectiveness, but highly expensive.