application of the malaria management model to the analysis of costs and benefits of ddt versus non-ddt malaria control疟疾管理模型的应用程序的成本与效益分析的ddt和non-ddt疟疾控制.pdf

Application of the Malaria Management Model to the Analysis of Costs and Benefits of DDT versus Non-DDT Malaria Control 1 1,2 2,3 Matteo Pedercini , Santiago Movilla Blanco , Birgit Kopainsky * 1 Millennium Institute, Washington, District of Columbia, United States of America, 2 System Dynamics Group, Department of Geography, University of Bergen, Bergen, Norway, 3 FluryGiuliani GmbH, Zurich, Switzerland Abstract Introduction: DDT is considered to be the most cost-effective insecticide for combating malaria. However, it is also the most environmentally persistent and can pose risks to human health when sprayed indoors. Therefore, the use of DDT for vector control remains controversial. Methods: In this paper we develop a computer-based simulation model to assess some of the costs and benefits of the continued use of DDT for Indoor Residual Spraying (IRS) versus its rapid phase out. We apply the prototype model to the aggregated sub Saharan African region. For putting the question about the continued use of DDT for IRS versus its rapid phase out into perspective we calculate the same costs and benefits for alternative combinations of integrated vector management interventions. Results: Our simulation results confirm that the current mix of integrated vector management interventions with DDT as the main insecticide is cheaper than the same mix with alternative insecticides when only direct costs are considered. However, combinations with a stronger focus on insecticide-treated bed nets and environmental management show higher levels of cost-effectiveness than interventions with a focus on IRS. Thus, this focus would also allow phasing out DDT in a cost- effective manner. Although a rapid phase out of DDT for