An Economic Evaluation of Home Management of Malaria in Uganda An Interactive Markov Model 英文参考文献.docVIP

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An Economic Evaluation of Home Management of Malaria in Uganda An Interactive Markov Model 英文参考文献.doc

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An Economic Evaluation of Home Management of Malaria in Uganda An Interactive Markov Model 英文参考文献

AnEconomicEvaluationofHomeManagementof MalariainUganda:AnInteractiveMarkovModel YoelLubell1,2*,AnneJ.Mills2,ChristopherJ.M.Whitty3,SarahG.Staedke3 1Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand, 2Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom, 3Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom Abstract Background: Home management of malaria (HMM), promoting presumptive treatment of febrile children in the community,isadvocatedtoimprovepromptappropriatetreatmentofmalariainAfrica.Thecost-effectivenessofHMMis likelytovarywidelyindifferentsettingsandwiththeantimalarialdrugsused.However,nodataonthecost-effectivenessof HMMprogrammesareavailable. Methods/PrincipalFindings:AMarkovmodelwasconstructedtoestimatethecost-effectivenessofHMMascomparedto conventionalcareforfebrileillnessesinchildrenwithoutHMM.ThemodelwaspopulatedwithdatafromUganda,butis designedtobeinteractive,allowingtheusertoadjustcertainparameters,includingtheantimalarialsdistributed.Themodel calculatesthecostperdisabilityadjustedlifeyearavertedandpresentstheincrementalcost-effectivenessratiocompared toathresholdvalue.Modeloutputisstratifiedbylevelofmalariatransmissionandtheprobabilitythatachildwouldreceive appropriatecarefromahealthfacility,toindicatethecircumstancesinwhichHMMislikelytobecost-effective.Themodel outputsuggeststhatthecost-effectivenessofHMMvarieswithmalariatransmission,theprobabilityofappropriatecare, andthedrugdistributed.Wheretransmissionishighandtheprobabilityofappropriatecareislimited,HMMislikelytobe cost-effective from a provider perspective. Even with the most effective antimalarials, HMM remains an attractive intervention only in areas of high malaria transmission and in medium transmission areas with a lower probability of appropriate care. HMM is generally not cost-effective in low transmission areas, regardless of