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Cost-Effectiveness of a Community-Based Approach Intertwined with a Vertical Aedes Control Program

We compared in a 5-year intervention study the cost-effectiveness of community-based environmental management intertwined with routine vertical Aedes control and of routine vertical control only. At baseline (year 2000), Aedes infestation levels and economic costs for vector control were comparable in intervention and control areas (house index, 2.23% versus 2.21% and US$21 versus US$24/yr/inhabitant, respectively). By 2004, house indices became 0.22% versus 2.36% and the costs were 29.8 US$ versus 36.7 US$/yr/inhabitant, respectively. The community cost made up 38.6% of the total economic cost in 2004 in the intervention areas against 23.5% in 2000. The average cost-effectiveness ratio for the intervention period 2001–2004, expressed as the societal cost incurred for the reduction (from baseline) of Aedes foci, was US$831.1 per focus in the intervention areas versus US$2,465.6 in the control areas. The intervention produced economic savings and health benefits that were sustained over the whole observation period.

Received March 21, 2008. Accepted for publication March 25, 2009.

Acknowledgments: The authors thank the role played by the health sector staff involved in the dengue prevention and Aedes control activities and by the people of Santiago de Cuba who participated in the study. The authors thank Dr. Jose A. Suaya for helpful comments on a draft of the manuscript.

Financial support: The study was funded by the Cuban Ministry of Health and through the framework agreement between the Institute of Tropical Medicine and the Belgian Directorate-General for Development Cooperation (Project 95900).

^* Address correspondence to Alberto Baly, Instituto de Medicina Tropical "Pedro Kourí," Subdireccion de Epidemiologia, Autopista Novia del Mediodia, Km 6 La Lisa, Ciudad de La Habana, Cuba. E-mails: baly{at}ipk.sld.cu or balygil{at}yahoo.com

Authors’ addresses: Alberto Baly, Maria E. Toledo, Alicia Reyes, and Idalmis Sanchez, Instituto de Medicina Tropical "Pedro Kourí," Subdireccion de Epidemiologia, Autopista Novia del Mediodia Km 6 La Lisa, Ciudad de La Habana, Cuba, Tel: 0053-7-2020652, E-mails: baly{at}ipk.sld.cu, balygil{at}yahoo.com, and mariaeugeniatoledo{at}yahoo.es. Veerle Vanlerberghe, Marleen Boelaert, and Patrick Van der Stuyft, Institute of Tropical Medicine, Epidemiology and Disease Control Unit, Nationalestraat 155, 2000 Antwerp, Belgium, Tel: 0032-32-47-62-55, Fax: 0032-32-47-62-58, E-mails: mboelaert{at}itg.be, vvanlerberghe{at}itg.be, and pvdstuyft{at}itg.be. Enrique Ceballos, Marinelli Carvajal, Rizel Maso, Maite La Rosa, and Orestes Denis, Unidad Provincial de Vigilancia y Lucha Antivectorial, Avenida Garzon, Santiago de Cuba, Cuba, E-mail: vectores{at}infosol.scu.sld.cu.

Reprint requests: Alberto Baly Gil, Instituto de Medicina Tropical "Pedro Kourí," Subdireccion de Epidemiologia, Autopista Novia del Mediodia, Km 6 La Lisa, Ciudad de La Habana, Cuba, Tel: 0053-7-2020652, E-mails: baly{at}ipk.sld.cu or balygil{at}yahoo.com.