インドの国立結核撲滅プログラムに栄養支援の介入を統合する経済評価:低所得国および中所得国への影響
Gaurav Jyani1, Shankar Prinja2, Sudheer Nadipally3
1Post Graduate Institute of Medical Education and Research, Chandigarh, India.
BMJ open
|September 4, 2025
まとめ
MUKTIイニシアチブを通じて栄養支援をインド国立結核撲滅プログラム (NTEP) に統合することは費用対効果的です. このアプローチにより 患者の治療成果が向上し 病気の伝染が減り 公衆衛生への投資に 大きな価値をもたらします
科学分野:
- 公共衛生経済学
- 感染症 管理
- 栄養学
背景:
- 結核 (TB) はインドにおける重要な公衆衛生上の課題であり,その根絶には革新的な戦略が必要である.
- 国立結核撲滅プログラム (NTEP) は標準的なケアを提供していますが,栄養などの社会経済的要因は治療結果に影響します.
- MUKTIイニシアチブは,これらの決定要因に対処するために,NTEPの枠組みに栄養支援を統合することを目的としています.
研究 の 目的:
- インドのNTEPにMUKTI栄養支援イニシアチブを統合する費用対効果を評価する.
- 栄養補助が患者の生活の質や 病気の伝播力学に与える影響を評価する.
- 介入によって得られる品質調整された寿命年あたりの付加コスト (QALY) を決定する.
主な方法:
- マルコフモデルと感受性感染回復モデルを組み合わせた数学的モデルを用いた経済評価
- インドの2615人の結核患者から,費用,自費,および健康関連の生活の質 (EuroQol 5次元5レベルスケール) に関する主要なデータ収集.
- 確率的な感受性分析とシナリオ分析 (コミュニティでの感染を除く) を2年以内に実施した.
主要な成果:
- NTEP + MUKTI プログラムは,NTEP 単独と比較して,より高い寿命年 (1,693 vs 1,622) とQALY (1,357 vs 1,294) をもたらしました.
- QALYあたりの増加コストは₹76,306 (US$919) で,インドの一人当たりのGDPの値を下回り,費用対効果を示しています.
- 費用対効果は主に コミュニティでの結核感染の減少によるものでした
結論:
- 栄養支援 (MUKTIイニシアチブ) をインドのNTEPに統合することは,結核の撲滅のための費用対効果の高い戦略です.
- 栄養などの社会経済的な決定因子に対処することは,総合的で効果的な公衆衛生アプローチにとって極めて重要です.
- コミュニティでの感染を減らすことが 結核患者の栄養介入の経済的利益の鍵です
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