在哥伦比亚部署 Wolbachia 的经济评估:模型研究

Donald S. Shepard, Samantha R. Lee, Yara A. Halasa-Rappel, Carlos Willian Rincon Perez, Arturo Harker Roa
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摘要

背景与目的狼杆菌是一种抑制蚊子体内登革热病毒复制的细菌。一项集群随机试验发现,沃尔巴克氏菌可将经病毒学确诊的登革热病例减少 77%,而根据先前的模型预测,沃尔巴克氏菌在印度尼西亚、越南和巴西具有很高的成本效益。为了给未来的推广决策提供信息,我们对将沃尔巴克氏菌推广到哥伦比亚 11 个目标城市的可能性进行了经济评估。方法我们收集了哥伦比亚国家疾病监测系统和医疗服务提供登记(RIPS)中报告的登革热病例的数量和严重程度分布。由三位专家组成的流行病学小组估算了非医疗病例的比例,并对漏报和误报进行了调整。我们根据基准保险费率、登革热病人服务登记册中每例无症状登革热病人的治疗服务数据以及用于确定保险费的国家政府数据库,确定了治疗登革热病的成本(2020 年美元)。一项分组随机试验对沃尔巴克氏菌治疗无症状登革热病例的效果进行了量化。结果我们对卡利市 10 年的影响进行了预测,估计卫生部门每人净节省 4.95 美元。我们还估计每 10 万人可避免 369 个残疾调整寿命年。从社会角度来看,沃尔巴克氏菌应用 10 年后,预计将产生非常有利的效益成本比,在卡利每投资 1 美元可产生 5.50 美元的效益,而在所有目标城市则可产生 4.68 美元的效益。也就是说,沃尔巴克氏菌仅在医疗保健方面节省的成本就足以抵消全国和 9 个目标城市(调整后登革热年发病率至少为 50/100,000 的城市)的部署成本。在这 9 个目标城市中,每投入 1 美元,沃尔巴克氏菌就能带来至少 3 美元的收益,这让人们对在哥伦比亚部署沃尔巴克氏菌的成本效益充满信心。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Economic evaluation of Wolbachia deployment in Colombia: A modeling study
Background and Aims Wolbachia are bacteria that inhibit dengue virus replication within the mosquito. A cluster-randomized trial found Wolbachia reduced virologically-confirmed dengue cases by 77% and previous models predicted Wolbachia to be highly cost-effective in Indonesia, Vietnam, and Brazil. in Colombia, Wolbachia was introduced in the Aburrá Valley in 2015 and Cali in 2020. To inform decisions about future extensions, we performed economic evaluations of the potential expansion of Wolbachia deployments to 11 target Colombian cities. Methods We assembled quantities and the distribution by severity of reported dengue cases from Colombia’s national disease surveillance system and the health service provision registry (RIPS). An epidemiological panel of three experts estimated the shares of non-medical cases and adjustments for under-reporting and misclassifications. We determined costs (in 2020 US dollars) of treating dengue illness from the benchmark insurance tariff, RIPS data on treatment services per symptomatic dengue case, and the national government database for establishing insurance premiums. A cluster randomized trial quantified the effectiveness of Wolbachia against symptomatic dengue cases. Results Projecting impact over 10 years for Cali, we estimated a net health-sector savings of USD4.95 per person. We also estimated averting 369 disability-adjusted life years (DALYs) per 100,000 population. From a societal perspective, at 10 years Wolbachia deployment is expected to have highly favorable benefit-cost ratios, with benefits per dollar invested of $5.50 in Cali and USD4.68 over all target cities. Conclusions Over 10 years, Wolbachia is highly beneficial on economic grounds, and almost universally cost saving. That is, Wolbachia’s savings in health care costs alone would more than offset deployment costs nationally and in 9 target cities (those with adjusted annual dengue incidence at least 50/100,000 population). In these 9 target cities, Wolbachia would generate at least USD3.00 in benefits per dollar invested, giving substantial confidence that Wolbachia deployment would be cost-beneficial in Colombia.
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