Cost-effectiveness of chagas disease vector control strategies in Northwestern Argentina.
<h4>Background</h4>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 Triato...
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doaj-2b18c8c3163a43e6b4520b42c23c13ac2021-03-03T08:02:40ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352009-01-0131e36310.1371/journal.pntd.0000363Cost-effectiveness of chagas disease vector control strategies in Northwestern Argentina.Gonzalo M Vazquez-ProkopecCynthia SpillmannMario ZaidenbergUriel KitronRicardo E Gürtler<h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions and significance</h4>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.https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/19156190/pdf/?tool=EBI |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Gonzalo M Vazquez-Prokopec Cynthia Spillmann Mario Zaidenberg Uriel Kitron Ricardo E Gürtler |
spellingShingle |
Gonzalo M Vazquez-Prokopec Cynthia Spillmann Mario Zaidenberg Uriel Kitron Ricardo E Gürtler Cost-effectiveness of chagas disease vector control strategies in Northwestern Argentina. PLoS Neglected Tropical Diseases |
author_facet |
Gonzalo M Vazquez-Prokopec Cynthia Spillmann Mario Zaidenberg Uriel Kitron Ricardo E Gürtler |
author_sort |
Gonzalo M Vazquez-Prokopec |
title |
Cost-effectiveness of chagas disease vector control strategies in Northwestern Argentina. |
title_short |
Cost-effectiveness of chagas disease vector control strategies in Northwestern Argentina. |
title_full |
Cost-effectiveness of chagas disease vector control strategies in Northwestern Argentina. |
title_fullStr |
Cost-effectiveness of chagas disease vector control strategies in Northwestern Argentina. |
title_full_unstemmed |
Cost-effectiveness of chagas disease vector control strategies in Northwestern Argentina. |
title_sort |
cost-effectiveness of chagas disease vector control strategies in northwestern argentina. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS Neglected Tropical Diseases |
issn |
1935-2727 1935-2735 |
publishDate |
2009-01-01 |
description |
<h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusions and significance</h4>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. |
url |
https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/19156190/pdf/?tool=EBI |
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