殺蟲劑應用於登革熱防疫之成本效用分析：以高雄市為例

Cost effectiveness of insecticide spraying for dengue epidemic control in Kaohsiung City

目標：登革熱為一蟲媒傳染病，廣泛流行於東南亞、美洲及西太平洋等地，危及民眾之健康生命安全，目前尚無有效治療方式，病媒防治為首要工作。本研究以成本效用分析探討登革熱疫情初期進行噴消之效用為何？研究成果期能提供防疫決策參考，透過有限資源降低疫情與社會負擔。方法：使用TreeagePro2011進行決策樹與敏感度分析，以噴消殺蟲劑與不噴消的疾病發生率與登革熱病患的醫療成本，及噴消所需的成本、傷殘調整生命年作為成本效用分析的參數。結果：決策樹分析結果確定個案半徑100公尺家戶內外同步強制噴藥暨地毯式孳生源清除較好。若進行噴消，當登革熱發生率在0.0536時，每人花費957.16元損失0.0144DALYs／百萬人；若不噴消，當發生率0.0954時，每人花費1,575.24元，更損失0.0257DALYs／百萬人，而發生率在0.058至0.091區間內，早期噴消符合成本效用。結論：本研究定義符合登革熱噴消成本效用的發生率區間，在區間外可搭配其他防疫措施（如孳生源清除、環境清理）降低後續登革（出血）熱之幅度及嚴重度。

Objectives: Dengue fever is a human health and life-threatening mosquito-borne disease in tropical regions of the world, and is prevalent in southeast Asia, Central America, South America, and the western Pacific region. Without effective treatment, insecticide spray to control the vector has been the top priority in attempts to prevent dengue transmission. This study evaluated the cost utility of insecticide spray in the early stage of a dengue outbreak in Kaohsiung. These results will provide suggestions for controlling dengue fever with limited resources and lowering the epidemic size and social burden of dengue fever. Methods: Decision-making and sensitivity analysis were performed with Treeage Pro 2011. The incidence of dengue fever with incorporation of the following factors into a decision tree: with or without early insecticide spraying; manpower; material expenditures; medical expenses of patients; and DALYs. Results: A cost utility analysis indicated that spontaneous spraying of insecticide and environmental clearance indoors and outdoors within a radius of 100 meters of the case premises was a better decision than no spray control. Specifically, it would cost 957.16 NTD/person and 0.0144 DALYs lost per 1 million population with an incidence of 0.0536 with insecticide spray. In contrast, it would cost 1575.24 NTD/person with and 0.0257 DALYs lost per 1 million population with an incidence of 0.0954 without insecticide spray. The early spray approach had good cost utility, with an incidence ranging from 0.058-0.091. Conclusions: This study defined a suitable incidence interval with cost utility with respect to dengue fever control using early insecticide spraying. Despite the cumulative incidence beyond this range, other control strategies may cooperate with insecticide spraying to reduce the outbreak and severity of dengue (hemorrhagic) fever.