背景：日本血吸虫病仍然是一个重要的公共卫生问题，因为它可能导致严重的后果和长期后遗症。事实证明，在中华人民共和国实施的综合控制策略可有效控制或阻断血吸虫病的传播。这项研究的目的是评估血吸虫病的疾病负担，并评估综合控制策略的成本效益，该策略侧重于在湖泊环境中控制血吸虫病的三个阶段的不同主要干预措施。为政策制定或规划提供参考。
方法：2009-2019年血吸虫病防治年度费用数据来源于江陵县防治规划实施者，湖北省,中国。经济成本以2009年不变人民币(人民币)提供。从江陵县血吸虫病防治站收集血吸虫病流行病学数据。血吸虫病的疾病负担是通过计算由于过早死亡而导致的寿命损失（YLL）来评估的。残疾生活年(YLDs)和残疾调整寿命年(DALYs)。DALY计算为YLL和YLD的总和。然后，我们通过将传播控制（2013-2016）或传播中断（2017-2019）的综合控制策略的平均成本与感染控制阶段的平均成本之间的差异（2009-2012）与不同控制阶段的血吸虫病DALYs之间的差异，确定比率进行了初步的成本效益分析。分析中使用了成本和DALY的描述性统计数据。
结果：2009-2019年江陵县血吸虫病防治总经济费用约为60688万元。感染控制阶段（2009-2012年），血吸虫病预防和控制的年均经济成本，传动控制（2013-2016），和传输中断（2017-2019）约为4198万元，分别为9019万元和2606万元。血吸虫病总体疾病负担呈下降趋势。同时,晚期病例的疾病负担呈上升趋势，DALY从943.72人年上升至1031.59人年。大多数疾病负担发生在45岁以上的年龄组(尤其是60岁以上的老年人)。以感染控制阶段为对照，综合控制策略的增量成本效益比为8505.5元/例避免，变速器控制阶段每DALY减少60131.6元，避免每病例2217.6元，在传输中断阶段，每DALY减少116.0元。
结论：实施综合防治策略后，血吸虫病的疾病负担明显下降。应加强对老年人群的监测和管理，以减轻疾病负担。仍然需要进行良好的研究，以检查血吸虫病综合控制策略的长期成本效益。图形抽象。
BACKGROUND: Schistosomiasis japonica remains an important public health concern due to its potential to cause severe outcomes and long-term sequelae. An integrated control strategy implemented in the Peoples\' Republic of China has been shown to be effective to control or interrupt the transmission of schistosomiasis. The objective of this study is to estimate the disease burden of schistosomiasis and assess the cost-effectiveness of the integrated control strategy focused on different major interventions at three stages for schistosomiasis control in a lake setting, to provide reference for policy making or planning.
METHODS: Annual cost data of schistosomiasis control during 2009-2019 were obtained from the control program implementers in Jiangling County, Hubei Province, China. Economic costs are provided in constant 2009 Chinese Yuan (CNY). Epidemiological data of schistosomiasis were collected from the Jiangling county station for schistosomiasis control. Disease burden of schistosomiasis was assessed by calculating years of life lost (YLLs) owing to premature death, years lived with disability (YLDs) and disability-adjusted life years (DALYs). DALYs were calculated as the sum of YLLs and YLDs. We then conducted a rudimentary cost-effectiveness analysis by determining the ratio by dividing the difference between the average cost of integrated control strategy at transmission control (2013-2016) or transmission interruption (2017-2019) and the average cost at stage of infection control (2009-2012) with the difference between the DALYs of schistosomiasis at different control stages. Descriptive statistics on the costs and DALYs were used in the analysis.
RESULTS: The total economic costs for schistosomiasis control in Jiangling County from 2009 to 2019 were approximately CNY 606.88 million. The average annual economic costs for schistosomiasis prevention and control at stages of infection control (2009-2012), transmission control (2013-2016), and transmission interruption (2017-2019) were approximately CNY 41.98 million, CNY 90.19 million and CNY 26.06 million respectively. The overall disease burden caused by schistosomiasis presented a downward trend. Meanwhile, the disease burden of advanced cases showed an upward trend with the DALY increased from 943.72 to 1031.59 person-years. Most disease burden occurred in the age group over 45 years old (especially the elderly over 60 years old). Taking the infection control stage as the control, the incremental cost-effectiveness ratio of integrated control strategy was CNY 8505.5 per
case averted, CNY 60 131.6 per DALY decreased at transmission control stage and CNY -2217.6 per
case averted, CNY -18 116.0 per DALY decreased at transmission interruption stage.
CONCLUSIONS: The disease burden of schistosomiasis decreased significantly with the implementation of the integrated prevention and control strategy. Surveillance and management on elder population should be strengthened to decrease diseases burden. There remains a need for well-conducted studies that examine the long-term cost-effectiveness of the integrated control strategy for schistosomiasis. GRAPHIC ABSTARCT.
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