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Cost-effectiveness of chagas disease vector control strategies in Northwestern Argentina.

Abstract：

BACKGROUND:Control and prevention of Chagas disease rely mostly on residual spraying of insecticides. In Argentina, vector control shifted from a vertical to a fully horizontal strategy based on community participation between 1992 and 2004. The effects of such strategy on Triatoma infestans, the main domestic vector, and on disease transmission have not been assessed. METHODS AND FINDINGS:Based on retrospective (1993-2004) records from the Argentinean Ministry of Health for the Moreno Department, Northwestern Argentina, we performed a cost-effectiveness (CE) analysis and compared the observed CE of the fully horizontal vector control strategy with the expected CE for a vertical or a mixed (i.e., vertical attack phase followed by horizontal surveillance) strategy. Total direct costs (in 2004 US$) of the horizontal and mixed strategies were, respectively, 3.3 and 1.7 times lower than the costs of the vertical strategy, due to reductions in personnel costs. The estimated CE ratios for the vertical, mixed and horizontal strategies were US$132, US$82 and US$45 per averted human case, respectively. When per diems were excluded from the costs (i.e., simulating the decentralization of control activities), the CE of vertical, mixed and horizontal strategies was reduced to US$60, US$42 and US$32 per averted case, respectively. CONCLUSIONS AND SIGNIFICANCE:The mixed strategy would have averted between 1.6 and 4.0 times more human cases than the fully horizontal strategy, and would have been the most cost-effective option to interrupt parasite transmission in the Department. In rural and dispersed areas where waning vertical vector programs cannot accomplish full insecticide coverage, alternative strategies need to be developed. If properly implemented, community participation represents not only the most appealing but also the most cost-effective alternative to accomplish such objectives.

journal_name

PLoS Negl Trop Dis

journal_title

PLoS neglected tropical diseases

authors

Vazquez-Prokopec GM,Spillmann C,Zaidenberg M,Kitron U,Gürtler RE

doi

10.1371/journal.pntd.0000363

subject

Has Abstract

pub_date

2009-01-01 00:00:00

pages

e363

issue

eissn

1935-2727

issn

1935-2735

journal_volume

pub_type

杂志文章

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Cost-effectiveness of chagas disease vector control strategies in Northwestern Argentina.