Background

The Italian and the European Centre for Disease Control and Prevention guidelines both recommend a systematic serological screening for strongyloidiasis in sub-Saharan migrants (SSA), however, studies on clinical and economic impact of this strategy in the Italian and European settings are lacking.

Methods

A population of 100,000 migrants from SSA to Italy was considered and a Markov decision tree model was developed to assess the clinical and economic impact of two interventions for strongyloidiasis compared with the current practice (passive diagnosis of symptomatic cases): a) universal serological screening and treatment with ivermectin in case of positive test b) universal presumptive treatment with ivermectin. One and 10-year time horizon in the health-care perspective were considered.

Results

In the one and 10-year time horizon respectively the costs for passive diagnosis was €1,164,169 and €9,735,908, those for screening option was € 2,856,011 and € 4,959,638 and those for presumptive treatment was €3,538,474 and € 4,883,272. Considering the cost per cured subject in the one-year time horizon, screening appears more favorable (€209.53), than the other two options (€232.55 per presumptive treatment and €10,197.29 per current strategy). Incremental cost-effectiveness ratio (ICERs) of screening strategy and presumptive treatment were respectively 265.27 and 333.19. The sensitivity analysis identified strongyloidiasis’ prevalence as the main driver of ICER.

Conclusions

Compared to the current practice (passive diagnosis) both screening and presumptive treatment strategies are more favorable from a cost-effectiveness point of view, with a slight advantage of the screening strategy in a one-year time horizon.

中文翻译：

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最近抵达意大利的撒哈拉以南非洲移民的类圆线虫病管理策略：成本效益分析。

背景

意大利和欧洲疾病控制和预防中心的指南均建议对撒哈拉以南移民 (SSA) 进行系统的类圆线虫病血清学筛查，但是，缺乏有关该策略在意大利和欧洲环境中的临床和经济影响的研究。

方法

考虑了从 SSA 到意大利的 100,000 名移民人口，并开发了马尔可夫决策树模型，以评估与当前实践（有症状病例的被动诊断）相比两种类圆线虫干预措施的临床和经济影响：a）普遍血清学筛查和b) 普遍假定的伊维菌素治疗。从医疗保健的角度考虑了 1 年和 10 年的时间范围。

结果

在一年和 10 年的时间范围内，被动诊断的成本分别为 1,164,169 欧元和 9,735,908 欧元，筛查选项的成本为 2,856,011 欧元和 4,959,638 欧元，推定治疗的成本为 3,538,474 欧元和 4,883 欧元，2 考虑到一年内每个治愈受试者的成本，筛查似乎比其他两种选择（每个假定治疗 232.55 欧元和每个当前策略 10,197.29 欧元）更有利（209.53 欧元）。筛选策略和推定治疗的增量成本效益比 (ICER) 分别为 265.27 和 333.19。敏感性分析确定类圆线虫病的流行是 ICER 的主要驱动因素。

结论

与目前的做法（被动诊断）相比，从成本效益的角度来看，筛查和推定治疗策略都更有利，在一年的时间范围内筛查策略略有优势。