新的研究说大力控制结核可产生巨大的经济收益

潮水

12 DECEMBER 2007 | WASHINGTON, D.C. -- A new World Bank research report finds that 22 countries with the world’s highest numbers of TB cases could earn significantly more than they spend on TB diagnosis and treatment if they signed onto a global plan to sharply reduce the numbers of TB-related deaths. Highly affected African countries could gain up to nine times their investments in TB control. The study also warns about the need to step up TB control worldwide with the growing emergence of multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) in southern Africa, eastern Europe and Central Asia.


The report says that despite recent gains in fighting TB, there were still 8.8 million new cases and 1.6 million deaths from the disease in 2005. Without treatment, two thirds of smear-positive cases die within five to eight years, with most dying within 18 months of being infected.

According to the study — "The economic benefit of global investments in tuberculosis control" — the economic impact of TB deaths and the benefits of TB control among the 22 high-burden countries are greatest in China and India, where the combination of growing incomes and a relatively high number of TB deaths translates into a significant economic effect.

The study, which was commissioned by the World Bank on behalf of the Stop TB Partnership and funded by the Bill and Melinda Gates Foundation, has attracted considerable interest from international health and development agencies, along with research and civil society groups, which want more aggressive TB control worldwide. The disease is the leading infectious killer of adults after HIV/AIDS.

“This report set out to test whether the economic benefits of TB control are greater than the costs. It turns out that likely benefits are of impressive magnitude,” said Dr Jorge Sampaio, the UN Secretary-General’s Special Envoy to Stop TB, and former President of Portugal.

What the study means for Africa
The study says that the economic cost of TB-related deaths (including HIV co-infection) in Sub-Saharan Africa from 2006 to 2015 is US$ 519 billion when there is no effective TB treatment as prescribed by WHO's Stop TB Strategy. However, if these same countries in Sub-Saharan Africa were to offer such treatment to TB patients, in keeping with a global plan to halve the prevalence and death rates by 2015 relative to 1990 figures, countries could see their economic benefits exceed their costs by about nine times over. The Global Plan to Stop TB, devised by the Stop TB Partnership, would cost US$ 2 billion a year for TB diagnosis and treatment until 2015 in Africa, and US$ 5-6 billion worldwide.

“There were already compelling reasons to fight TB, which causes massive human suffering. Now, as a further incentive, there are strong indications that investment in meeting the Millennium Development Goal related to TB carries important economic benefits,” said Dr Margaret Chan, Director-General of WHO.

Stepping up TB treatment also makes economic sense outside Africa. The study finds that the economic return would be even higher in countries such as China and India, where income growth projections over the next 10 years are higher and the burden of HIV co-infection lower.

TB worsens poverty
The new study says that by sickening or killing working-age adults, TB imposes a heavy cost on people’s incomes as well as national economies. For example, in Zambia, adult deaths among small maize and cotton farmers caused crop yields to fall by roughly 15%. Children are vulnerable to TB as well, and the disease may force them out of school, limiting their future job prospects.

“This important new study shows us why TB control is a smart investment in lasting development for low- and middle-income countries,” said Joy Phumaphi, World Bank Vice-President for Human Development, a former WHO Assistant Director General and former Health Minister in Botswana. “This economic justification for TB control strengthens the case for governments and donors to sharply reduce TB prevalence and deaths in the name of better health and higher incomes for people living at grave risk of TB illness and death.”

Phumaphi says the World Bank will intensify its support for TB control, while continuing to work with countries in eastern Europe, Central Asia and South Asia. In Africa, she says the Bank will take a more proactive approach to financing country-led efforts, using existing channels, sector-wide programmes, combined HIV and TB control programmes, and multi-sectoral operations.

Looking ahead
The study calls for urgently accelerated global TB control because of multiple factors: the extraordinary burden of TB on those afflicted by the disease, their families, and on government budgets; the dramatic growth of TB cases over more than a decade in eastern Europe and Central Asia; and the emergence of MDR-TB and XDR-TB. TB patients in eastern Europe and Central Asia are 10 times more likely to have MDR-TB than in other regions of the world, and up to 15% of new cases are multi-drug resistant. The report says the threat of MDR-TB underscores the urgency for all TB-affected countries and health and development agencies to push for the fullest possible adoption of the Global Plan to Stop TB; the plan calls for a shared investment by countries heavily affected by TB and donors.

"This report should wake up countries to the urgent need for a stronger financial commitment to TB control," said Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. "Effective TB control has a positive impact on the lives of the millions of people infected with TB, on whole communities and it reduces the burden of disease on national economies."

The 22 countries with a high burden of TB are: Afghanistan, Bangladesh, Brazil, Cambodia, China, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Kenya, Mozambique, Myanmar, Nigeria, Pakistan, Philippines, Russian Federation, South Africa, Thailand, Uganda, United Republic of Tanzania, Viet Nam and Zimbabwe.

The Global Plan to Stop TB, launched by the Stop TB Partnership in January 2006, sets forth a roadmap for treating 50 million people for TB and enrolling 3 million patients who have both TB and human immunodeficiency infection on antiretroviral therapy over the next 10 years, saving about 14 million lives. It aims to halve TB prevalence and deaths compared with 1990 levels by 2015.

The Stop TB Partnership, which is hosted by WHO in Geneva, Switzerland, is a network of more then 500 international organizations, countries, donors from the public and private sectors, and nongovernmental and governmental organizations that are working together to eliminate TB.

The Stop TB Strategy, launched by WHO in 2006, includes the following priorities:

pursue high-quality DOTS expansions and enhancement (the DOTS approach to TB control emphasizes bacteriologically-based case detection and standardized treatment with patient support, effective drug supply and monitoring and evaluation);
address TB/HIV, MDR-TB and other challenges;
contribute to health system strengthening;
engage all care providers;
empower people with TB and communities; and
enable and promote research.
2007年12月12日 | 华盛顿（哥伦比亚特区） -- 世界银行一份新的研究报告发现，如果签署大量减少结核相关死亡人数的一项全球计划，世界上结核病例数最多的22个国家的收益会显著多于它们用于结核诊断和治疗的费用。受到高度影响的非洲国家的收益可达结核控制投资的9倍。该项研究还告诫，必须在世界范围内加强结核控制，因为耐多药结核和广泛耐药结核的出现在非洲南部、东欧和中亚正在日益增多。

报告说，尽管最近在防治结核方面取得了进展，但2005年该病仍造成880万新病例和160万例死亡。如不进行治疗，三分之二的痰涂阳性病例将在5至8年内死亡，多数在感染之后18个月之内死亡。

根据题为“全球结核控制投资的经济效益”的一项研究，在22个高负担国家中，结核死亡和结核控制效益造成最大经济影响的国家是中国和印度，收入增长和相对较高的结核死亡人数相结合产生显著的经济影响。

该项研究由世界银行代表控制结核伙伴关系委托开展并得到比尔和梅林达•盖茨基金会的资助，引起了要求在世界范围内加大结核控制力度的国际卫生和开发机构以及研究团体和民间社会团体的极大关注。该病是成人的主要传染病杀手，仅次于艾滋病毒/艾滋病。

“报告着手研究结核控制的经济效益是否高于成本。结果是可能效益规模巨大，”联合国秘书长控制结核特使Jorge Sampaio博士（原葡萄牙总统）说。

该项研究对非洲的意义
据该项研究说，如果没有世卫组织控制结核战略规定的有效结核治疗，2006至2015年南撒哈拉非洲结核相关死亡（包括合并感染艾滋病毒）的经济费用为5190亿美元。但是，如果南撒哈拉非洲的这些国家遵照到2015年按1990年的数据使患病率和死亡率减少一半的全球计划向结核患者提供此类治疗，各国的经济收益可超过成本的9倍。控制结核伙伴关系制定的控制结核全球计划2015年之前每年用于结核诊断和治疗的费用在非洲为20亿美元，在全世界为50-60亿美元。

“防治结核已有令人信服的理由，因为结核造成巨大的人间痛苦。现在，有可靠的迹象说明投资于实现与结核相关的千年发展目标具有重大经济效益，这是进一步的推动力，”世卫组织总干事陈冯富珍博士说。

在非洲之外，加强结核治疗也具有经济意义。该项研究发现，在今后10年内收入增长预测较高而艾滋病毒合并感染负担较低的国家，例如中国和印度，经济回报甚至会更高。

结核加剧贫穷
据这项新的研究说，通过造成就业年龄组成人患病或死亡，结核对人民的收入及国家经济产生巨大费用。例如，赞比亚种植玉米和棉花的小型农场主中的成人死亡使作物产量下降约15%。儿童也易患结核，该病可迫使他们辍学，从而使他们未来的就业前景受到限制。

“这项重要的新研究向我们表明，为什么结核控制是低收入和中等收入国家持续发展的一项明智的投资，”曾任世卫组织助理总干事和博茨瓦纳卫生部长的世界银行人类发展问题副行长Joy Phumaphi说。

“控制结核的经济理由使政府和捐助者更加应当大幅降低结核患病率和死亡人数，以便为处于结核产生的疾病和死亡严重风险中的人们提高健康和收入水平。”

Phumaphi说世界银行将加强对结核控制的支持，并同时继续与东欧、中亚和南亚各国合作。在非洲，她说世行将采取更加积极主动的措施以资助国家带头作出努力，利用现有渠道、全部门的规划、艾滋病毒和结核综合控制规划以及多部门的行动。

前景
这项研究呼吁迫切地加快全球结核控制，因为存在以下多种因素：结核对患者、其家庭和政府预算造成的巨大负担；在过去10多年中，东欧和中亚结核病例的急剧增多；以及耐多药结核和广泛耐药结核的出现。东欧和中亚的结核病人患耐多药结核的可能性比世界上其它区域的结核病人高10倍，而且多达15%的新病例是耐多药结核病例。报告说，耐多药结核的威胁突出地说明迫切需要所有受结核影响的国家以及各卫生和开发机构努力争取尽可能充分采用控制结核全球计划；该计划要求受结核严重影响的国家和各捐助者共同投资。

“该报告应当使各国清醒地看到，迫切需要对控制结核给予更坚定的财政承诺，”抗艾滋病、结核和疟疾全球基金执行主任Michel Kazatchkine说。“有效的结核控制对感染结核的成百万人的生命和社区整体具有积极的影响，而且可减轻国家经济承受的疾病负担。

结核负担沉重的22个国家为：阿富汗、孟加拉国、巴西、柬埔寨、中国、刚果民主共和国、埃塞俄比亚、印度、印度尼西亚、肯尼亚、莫桑比克、缅甸、尼日利亚、巴基斯坦、菲律宾、俄罗斯联邦、南非、泰国、乌干达、坦桑尼亚联合共和国、越南和津巴布韦。

控制结核全球计划由控制结核伙伴关系在2006年1月启动，提出了一个路线图，在今后10年期间治疗5000万结核患者并使300万兼患结核和人类免疫缺陷感染的患者接受抗逆转录病毒治疗，从而拯救约1400万人的生命。其目的是到2015年使结核患病率和死亡人数与1990年的水平相比减少一半。

控制结核伙伴关系由瑞士日内瓦的世卫组织主持，是500多个国际组织、国家、公立和私立部门捐助者以及非政府组织和政府组织组成的网络，一起开展工作以消灭结核。

控制结核战略由世卫组织在2006年启动，包括如下优先事项：

开展高质DOTS推广和强化工作（控制结核的DOTS措施强调以细菌学为基础得到病人支持的病例发现和标准化治疗、有效的药物供应以及监测和评价）；
应对结核/艾滋病毒、耐多药结核及其它挑战；
促进加强卫生系统；
使所有保健提供者参与；
提高结核患者和社区的能力；以及
实施和促进研究。
（摘自世界卫生组织网站）

[ 本帖最后由 潮水 于 2007-12-21 23:03 编辑 ]