背景:2017年,利比里亚成为非洲地区首批制定和实施被忽视的热带病综合病例管理国家战略(CM-NTD)的国家之一,特别是布鲁里溃疡,麻风病,淋巴丝虫病的发病率,还有Yaws.实施该计划将NTD计划从许多国家/地区转移到“零散(垂直)疾病管理”。这项研究探讨了综合方法在多大程度上为国家卫生系统提供了具有成本效益的投资。
方法:本研究是一项混合方法的经济评估,探讨了集成CM-NTDs方法与零散(垂直)疾病管理相比的成本效益。从两个综合干预县和两个非干预县收集主要数据,以确定综合方案模型与分散(垂直)的护理。数据来自NTDs计划年度预算和综合CM-NTDs和大众药物管理局(MDA)的财务报告,以确定成本驱动因素和有效性。
结果:从2017年到2019年,集成CM-NTD方法产生的总成本为789,856.30美元,其中计划人员配备和动机的成本百分比最高(41.8%),其次是营运成本(24.8%)。在实施分散(垂直)疾病管理的两个县,约325,000美元用于诊断84人和治疗24名患有NTD的人。虽然在综合县的支出是综合县的2.5倍,诊断和治疗的患者增加了9-10倍。
结论:患者在零散(垂直)实施下被诊断的成本是集成CM-NTDs的五倍,提供治疗的费用是其十倍。调查结果表明,综合CM-NTD战略已经实现了改善对NTD服务的访问的主要目标。在利比里亚成功实施综合管理-NTD方法,本文提出的,证明NTD集成是一种成本最小化的解决方案。
BACKGROUND: In 2017, Liberia became one of the first countries in the African region to develop and implement a national strategy for integrated
case management of Neglected Tropical Diseases (CM-NTDs), specifically Buruli ulcer, leprosy, lymphatic filariasis morbidities, and yaws. Implementing this plan moves the NTD program from many countries\' fragmented (vertical) disease management. This study explores to what extent an integrated approach offers a cost-effective investment for national health systems.
METHODS: This study is a mixed-method economic evaluation that explores the cost-effectiveness of the integrated CM-NTDs approach compared to the fragmented (vertical) disease management. Primary data were collected from two integrated intervention counties and two non-intervention counties to determine the relative cost-effectiveness of the integrated program model vs. fragmented (vertical) care. Data was sourced from the NTDs program annual budgets and financial
reports for integrated CM-NTDs and Mass Drug Administration (MDA) to determine cost drivers and effectiveness.
RESULTS: The total cost incurred by the integrated CM-NTD approach from 2017 to 2019 was US$ 789,856.30, with the highest percentage of costs for program staffing and motivation (41.8%), followed by operating costs (24.8%). In the two counties implementing fragmented (vertical) disease management, approximately US$ 325,000 was spent on the diagnosis of 84 persons and the treatment of twenty-four persons suffering from NTDs. While 2.5 times as much was spent in integrated counties, 9-10 times more patients were diagnosed and treated.
CONCLUSIONS: The cost of a patient being diagnosed under the fragmented (vertical) implementation is five times higher than integrated CM-NTDs, and providing treatment is ten times as costly. Findings indicate that the integrated CM-NTDs strategy has achieved its primary objective of improved access to NTD services. The success of implementing an integrated CM-NTDs approach in Liberia, presented in this paper, demonstrates that NTD integration is a cost-minimizing solution.