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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Autores principales:	Gonzalo M Vazquez-Prokopec, Cynthia Spillmann, Mario Zaidenberg, Uriel Kitron, Ricardo E Gürtler
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2009
Materias:	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/2b18c8c3163a43e6b4520b42c23c13ac
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spelling	oai:doaj.org-article:2b18c8c3163a43e6b4520b42c23c13ac2021-12-02T20:23:54ZCost-effectiveness of chagas disease vector control strategies in Northwestern Argentina.1935-27271935-273510.1371/journal.pntd.0000363https://doaj.org/article/2b18c8c3163a43e6b4520b42c23c13ac2009-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/19156190/pdf/?tool=EBIhttps://doaj.org/toc/1935-2727https://doaj.org/toc/1935-2735<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.Gonzalo M Vazquez-ProkopecCynthia SpillmannMario ZaidenbergUriel KitronRicardo E GürtlerPublic Library of Science (PLoS)articleArctic medicine. Tropical medicineRC955-962Public aspects of medicineRA1-1270ENPLoS Neglected Tropical Diseases, Vol 3, Iss 1, p e363 (2009)
institution	DOAJ
collection	DOAJ
language	EN
topic	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270
spellingShingle	Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Gonzalo M Vazquez-Prokopec Cynthia Spillmann Mario Zaidenberg Uriel Kitron Ricardo E Gürtler Cost-effectiveness of chagas disease vector control strategies in Northwestern Argentina.
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.
format	article
author	Gonzalo M Vazquez-Prokopec Cynthia Spillmann Mario Zaidenberg Uriel Kitron Ricardo E Gürtler
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)
publishDate	2009
url	https://doaj.org/article/2b18c8c3163a43e6b4520b42c23c13ac
work_keys_str_mv	AT gonzalomvazquezprokopec costeffectivenessofchagasdiseasevectorcontrolstrategiesinnorthwesternargentina AT cynthiaspillmann costeffectivenessofchagasdiseasevectorcontrolstrategiesinnorthwesternargentina AT mariozaidenberg costeffectivenessofchagasdiseasevectorcontrolstrategiesinnorthwesternargentina AT urielkitron costeffectivenessofchagasdiseasevectorcontrolstrategiesinnorthwesternargentina AT ricardoegurtler costeffectivenessofchagasdiseasevectorcontrolstrategiesinnorthwesternargentina
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Cost-effectiveness of chagas disease vector control strategies in Northwestern Argentina.

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