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标题：Economic evaluation of disease elimination: An extension to the net-benefit framework and application to human African trypanosomiasis
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作者：Marina Antillon ; Ching-I Huang ; Kat S. Rock 等
期刊名称：Proceedings of the National Academy of Sciences
印刷版ISSN：0027-8424
电子版ISSN：1091-6490
出版年度：2021
卷号：118
期号：50
DOI：10.1073/pnas.2026797118
语种：English
出版社：The National Academy of Sciences of the United States of America
摘要：Significance While the health economic implications of disease elimination have been discussed before, the combination of uncertainty, cost effectiveness, and elimination has not been tackled before. We propose a modification to the net-benefit framework to explicitly consider the implications of switching from an optimal strategy, in terms of cost-per-burden averted, to a strategy with a higher likelihood of meeting the global target of elimination. The modification proposed yields a methodology to quantify the efficiency of elimination and to aid discussions among stakeholders with different objectives. We apply our method to strategies against human African trypanosomiasis in three settings, but this method is flexible enough that it can be applied directly to any simulation-based studies of disease elimination efforts. The global health community has earmarked a number of diseases for elimination or eradication, and these goals have often been praised on the premise of long-run cost savings. However, decision makers must contend with a multitude of demands on health budgets in the short or medium term, and costs per case often rise as the burden of a disease falls, rendering such efforts beyond the cost-effective use of scarce resources. In addition, these decisions must be made in the presence of substantial uncertainty regarding the feasibility and costs of elimination or eradication efforts. Therefore, analytical frameworks are necessary to consider the additional effort for reaching global goals, like elimination or eradication, that are beyond the cost-effective use of country resources. We propose a modification to the net-benefit framework to consider the implications of switching from an optimal strategy, in terms of cost-per-burden averted, to a strategy with a higher likelihood of meeting the global target of elimination or eradication. We illustrate the properties of our framework by considering the economic case of efforts to eliminate the transmission of gambiense human African trypanosomiasis (gHAT), a vector-borne, parasitic disease in West and Central Africa, by 2030.
关键词：eradication; elimination; economic evaluation; mathematical modeling