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反应性、靶向室内滞留喷雾剂在低传播环境中可有效控制疟疾
作者:小柯机器人 发布时间:2021/2/28 15:57:48

英国伦敦卫生与热带医学院David Bath团队研究了反应性、有针对性的室内滞留喷雾剂在低传播环境中控制疟疾的效果和成本效益。2021年2月27日,《柳叶刀》杂志发表了该成果。

杀虫剂费用的增加和疟疾预算的限制可能使诸如室内滞留喷洒(IRS)等普遍的病媒控制战略在低传播环境中不可持续。研究组调查了一个反应性的、靶向的IRS策略的有效性和成本效益。

这项分组随机、开放标签、非劣效性试验比较了南非东北部两个疟疾季(2015-17)的反应性靶向IRS与标准IRS实践。在标准IRS集群中,项目负责人利用历史数据、专家意见和其他因素进行了年度大规模喷洒活动,确定了优先领域。在靶向IRS集群中,只有指数病例的房屋(通过被动监测确定)及其近邻被喷洒。非劣效性边缘为1例/1000人-年。估计每伤残调整生命年(DALY)的增量成本,并进行确定性和概率敏感性分析。

标准IRS组疟疾发病率为0.95/1000人-年,靶向IRS组疟疾发病率为1.05/1000人-年,对应的发病率差异为0.10/1000人-年,表明了靶向IRS的非劣效性。每增加一个DALY,靶向IRS节省7845美元,相对于南非合理的成本效益阈值,转换为靶向IRS的成本效益概率为94–98%。根据使用的阈值,靶向IRS在发病率低于每1000人-年2.0–2.7的情况下仍具有成本效益。研究结果对其他参数的合理变化是稳健的。

研究结果表明,靶向IRS不逊于标准IRS,且安全、成本较低、成本效益较高。节省的资源可以重新分配给其他疟疾控制和消除活动。

附:英文原文

Title: Effectiveness and cost-effectiveness of reactive, targeted indoor residual spraying for malaria control in low-transmission settings: a cluster-randomised, non-inferiority trial in South Africa

Author: David Bath, Jackie Cook, John Govere, Phillemon Mathebula, Natashia Morris, Khumbulani Hlongwana, Jaishree Raman, Ishen Seocharan, Alpheus Zitha, Matimba Zitha, Aaron Mabuza, Frans Mbokazi, Elliot Machaba, Erik Mabunda, Eunice Jamesboy, Joseph Biggs, Chris Drakeley, Devanand Moonasar, Rajendra Maharaj, Maureen Coetzee, Catherine Pitt, Immo Kleinschmidt

Issue&Volume: 2021/02/27

Abstract:

Background

Increasing insecticide costs and constrained malaria budgets could make universal vector control strategies, such as indoor residual spraying (IRS), unsustainable in low-transmission settings. We investigated the effectiveness and cost-effectiveness of a reactive, targeted IRS strategy.

Methods

This cluster-randomised, open-label, non-inferiority trial compared reactive, targeted IRS with standard IRS practice in northeastern South Africa over two malaria seasons (2015–17). In standard IRS clusters, programme managers conducted annual mass spray campaigns prioritising areas using historical data, expert opinion, and other factors. In targeted IRS clusters, only houses of index cases (identified through passive surveillance) and their immediate neighbours were sprayed. The non-inferiority margin was 1 case per 1000 person-years. Health service costs of real-world implementation were modelled from primary and secondary data. Incremental costs per disability-adjusted life-year (DALY) were estimated and deterministic and probabilistic sensitivity analyses conducted. This study is registered with ClinicalTrials.gov, NCT02556242.

Findings

Malaria incidence was 0·95 per 1000 person-years (95% CI 0·58 to 1·32) in the standard IRS group and 1·05 per 1000 person-years (0·72 to 1·38) in the targeted IRS group, corresponding to a rate difference of 0·10 per 1000 person-years (–0·38 to 0·59), demonstrating non-inferiority for targeted IRS (p<0·0001). Per additional DALY incurred, targeted IRS saved US$7845 (2902 to 64907), giving a 94–98% probability that switching to targeted IRS would be cost-effective relative to plausible cost-effectiveness thresholds for South Africa ($2637 to $3557 per DALY averted). Depending on the threshold used, targeted IRS would remain cost-effective at incidences of less than 2·0–2·7 per 1000 person-years. Findings were robust to plausible variation in other parameters.

Interpretation

Targeted IRS was non-inferior, safe, less costly, and cost-effective compared with standard IRS in this very-low-transmission setting. Saved resources could be reallocated to other malaria control and elimination activities.

DOI: 10.1016/S0140-6736(21)00251-8

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00251-8/fulltext

期刊信息

LANCET:《柳叶刀》,创刊于1823年。隶属于爱思唯尔出版社,最新IF:59.102
官方网址:http://www.thelancet.com/
投稿链接:http://ees.elsevier.com/thelancet