论文部分内容阅读
背景:巴西里约热内卢,中等收入地区,成人的HIV感染率约为1%。目标:评价里约热内卢市的DOTS项目成本-效益。设计:根据里约热内卢市卫生局的成本数据和以项目结果为基础的流行病学模型进行成本-效益分析研究。按零售市场价格估算成本数据,并从公开发表的文献采集流行病学数据。结果:10年自服药形式(SAT)的结核病项目服务262000人口的成本约为580271$,而DOTS形式结核病项目的成本则为1047886$。DOTS预算的最大部分是人员成本和病人成本,各占28%。而SAT预算的最大部分是药物成本,占34%。从SAT形式到DOTS形式可以减少1558 例结核病人(不确定范围[UR]:1418-1704)和143例结核病死亡病人(不确定范围[UR]:131-155)。DOTS的边际成本-效益比(ICER)为300$/减少一例病人(不确定范围[UR]:289-312),3270$/减少一例结核病死亡(不确定范围[UR]:3123-3435)。如果采用失能调整年指标(DALYS),DOTS可减少5426个DALYs损失(不确定范围[UR]:4906-5961)。DOTS的边际成本-效益比为86$/DALY(不确定范围[UR]:74-100)。结论:在巴西,DOTS是具有高度成本-效益比的卫生干预措施。
Background: In Rio de Janeiro, Brazil, in middle-income areas, the HIV infection rate in adults is about 1%. Objective: To evaluate the cost-effectiveness of the DOTS project in Rio de Janeiro. Design: Conduct a cost-benefit analysis study based on cost data from the City of Rio de Janeiro Health Authority and an epidemiological model based on project results. Estimate cost data at retail market prices and collect epidemiological data from published literature. RESULTS: The cost of a TB population of 262,000 people in the self-medication form (SAT) of 10 years was approximately 580271$, while that of the DOTS-form TB program was 1,047,786$. The largest part of the DOTS budget is personnel costs and patient costs, each accounting for 28%. The largest part of the SAT budget is drug costs, which account for 34%. From the SAT form to the DOTS form, 1558 TB patients (uncertain range [UR]: 1418-1704) and 143 TB death patients (indetermined range [UR]: 131-155) can be reduced. The marginal cost-effectiveness ratio (ICER) of DOTS is 300$/reduction of one patient (uncertain range [UR]: 289-312), and 3270$/reduction of one tuberculosis death (determined range [UR]: 3123-3435). If DALYS is used, DOTS can reduce 5426 DALYs losses (uncertainty range [UR]: 4906-5961). The marginal cost-benefit ratio of DOTS is 86$/DALY (uncertain range [UR]: 74-100). Conclusion: In Brazil, DOTS is a health care intervention with a high cost-effectiveness ratio.