Application of the Malaria Management Model to the Analysis of Costs and Benefits of DDT versus Non-DDT Malaria Control 英文参考文献.docVIP

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Application of the Malaria Management Model to the Analysis of Costs and Benefits of DDT versus Non-DDT Malaria Control 英文参考文献.doc

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Application of the Malaria Management Model to the Analysis of Costs and Benefits of DDT versus Non-DDT Malaria Control 英文参考文献

ApplicationoftheMalariaManagementModeltothe AnalysisofCostsandBenefitsofDDTversusNon-DDT MalariaControl MatteoPedercini1,SantiagoMovillaBlanco1,2,BirgitKopainsky2,3 * 1MillenniumInstitute,Washington,DistrictofColumbia,UnitedStatesofAmerica,2SystemDynamicsGroup,DepartmentofGeography,UniversityofBergen,Bergen, Norway,3FluryGiulianiGmbH,Zurich,Switzerland Abstract Introduction:DDTisconsideredtobethemostcost-effectiveinsecticideforcombatingmalaria.However,itisalsothemost environmentallypersistentandcanposeriskstohumanhealthwhensprayedindoors.Therefore,theuseofDDTforvector controlremainscontroversial. Methods:Inthispaperwedevelopacomputer-basedsimulationmodeltoassesssomeofthecostsandbenefitsofthe continueduseofDDTforIndoorResidualSpraying(IRS)versusitsrapidphaseout.Weapplytheprototypemodeltothe aggregatedsubSaharanAfricanregion.ForputtingthequestionaboutthecontinueduseofDDTforIRSversusitsrapid phase out into perspective we calculate the same costs and benefits for alternative combinations of integrated vector managementinterventions. Results:OursimulationresultsconfirmthatthecurrentmixofintegratedvectormanagementinterventionswithDDTasthe maininsecticideischeaperthanthesamemixwithalternativeinsecticideswhenonlydirectcostsareconsidered.However, combinationswithastrongerfocusoninsecticide-treatedbednetsandenvironmentalmanagementshowhigherlevelsof cost-effectiveness than interventions with a focus on IRS. Thus, this focus would also allow phasing out DDT in a cost- effectivemanner.AlthougharapidphaseoutofDDTforIRSisthemostexpensiveofthetestedinterventioncombinations it can have important economic benefits in addition to health and environmental impacts that are difficult to assess in monetaryterms.Thoseeconomicbenefitscapturedbythemodelincludetheavoidedriskoflossesinagriculturalexports. Conclusions:Theprototypesimulationmodelillustrateshowacomputer-basedscenarioanalysistoolcaninformdebates on malaria control policies in general and on the continued use of DDT for IRS versu