[Cost-effectiveness evaluation on comprehensive control measures carrying out in schistosomiasis endemic areas with regard to different layers of administrative villages stratified by infection situation of human and domestic animals. I. Cost-effectiveness study in inner embankment of marshland and lake regions from 2006 to 2010]

Abstract

Objective: To evaluate the cost-effectiveness of the comprehensive control measures carrying out in schistosomiasis endemic inner embankment of marshland and lake regions from 2006 to 2010, so as to provide the reference for further rational allocation of limited health resources and ultimately speeding up the procedure of schistosomiasis elimination.

Methods: With reference to the requirements of the national schistosomiasis transmission control and phase goals for schistosomiasis control in Hubei Province, Jiangling County, one schistosomiasis control pilot of Hubei Province combined with the National Health and Family Planning Commission and Ministry of Agriculture, was selected for the study. A definition of the infection rates of human and domestic animals was used for endemic villages stratified by different layers (i.e., the village with the infection rates of human and domestic animals ≥ 3% belonged to the first layer, ≥ 1% belonged to the second layer; < 1% belonged to the third layer). By using the stratification method and cost-effectiveness analysis, the endemic villages stratified with the different layers were investigated and all the data of schistosomiasis endemic situation, cost and effectiveness of schistosomiasis control were collected and comprehensively analyzed from 2006 to 2010.

Results: In the effectiveness of schistosomiasis control, by the end of 2010, there were no first layer villages, there were 114 second layer villages, and there were 18 third layer villages in Jiangling County. In the former first layer villages, the schistosomiasis patients decreased year by year ultimately to 0; but in the second and third layer villages, the schistosomiasis patients increased. In the fecal treatment and management, the coverage rates of harm less sanitary latrines were 27.45% in 2009 and 48.74% in 2010 respectively in the second layer villages, whereas there were no harmless sanitary latrines in the first and third layer villages. In the 5 years, the input of comprehensive control measures was 10 266 3900 Yuan, much higher than the human and buffalo examinations and treatments, Oncomelania hupensis snail investigation and elimination (4 183 000 Yuan) and other labor inputs (2 239 500 Yuan). In the ratio of cost-effectiveness, the annual ratio of unit cost (1% reduction of human and buffalo infection and 1 hm2 reduction of snail areas) increased yearly. In addition, the semi-logarithmic stability trend analysis of health inputs and cost showed that there was a stable balance between inputs and cost in the different layers (logarithmic values of any two layers of pair-wise comparison were < 1, and in the third layer villages, the annual average logarithmic values of 5 years were < 1). Whereas, in the first and second layer villages, the annual average cost was fluctuated (the costs was higher than the inputs).

Conclusion: The schistosomiasis situation is reduced year by year in Jiangling County from 2006 to 2010. Whereas, the main infection source (buffaloes) still exists and the present control measures including fecal management should be further strengthened. In the resource allocation, in the field of health, the annual distribution of key inputs and unit-cost control also has a further space of adjustment.