Abstract
More than 1·5 billion people are affected by schistosomiasis or soil-transmitted helminthiasis. WHO's recommendations for mass drug administration (MDA) against these parasitic infections emphasise treatment of school-aged children, using separate treatment guidelines for these two helminthiases groups. We aimed to evaluate the cost-effectiveness of expanding integrated MDA to the entire community in four settings in Côte d'Ivoire. We extended previously published, dynamic, age-structured models of helminthiases transmission to simulate costs and disability averted with integrated MDA (of praziquantel and albendazole) for schistosomiasis and soil-transmitted helminthiasis. We calibrated the model to data for prevalence and intensity of species-specific helminth infection from surveys undertaken in four communities in Côte d'Ivoire between March, 1997, and September, 2010. We simulated a 15-year treatment programme with 75% coverage in only school-aged children; school-aged children and preschool-aged children; adults; and the entire community. Treatment costs were estimated at US$0·74 for school-aged children and $1·74 for preschool-aged children and adults. The incremental cost-effectiveness ratio (ICER) was calculated in 2014 US dollars per disability-adjusted life-year (DALY) averted. Expanded community-wide treatment was highly cost effective compared with treatment of only school-aged children (ICER $167 per DALY averted) and WHO guidelines (ICER $127 per DALY averted), and remained highly cost effective even if treatment costs for preschool-aged children and adults were ten times greater than those for school-aged children. Community-wide treatment remained highly cost effective even when elimination of helminth infections was not achieved. These findings were robust across the four diverse communities in Côte d'Ivoire, only one of which would have received annual MDA for both schistosomiasis and soil-transmitted helminthiasis under the latest WHO guidelines. Treatment every 6 months was also highly cost effective in three out of four communities. Integrated, community-wide MDA programmes for schistosomiasis and soil-transmitted helminthiasis can be highly cost effective, even in communities with low disease burden in any helminth group. These results support an urgent need to re-evaluate current global guidelines for helminthiases control programmes to include community-wide treatment, increased treatment frequency, and consideration for lowered prevalence thresholds for integrated treatment. Stanford University Medical Scholars Programme, Mount Sinai Hospital-University Health Network AMO Innovation Fund.
Highlights
This change has been shown in the increased international funding for mass treatment campaigns from foreign aid programmes, nongovernmental organisations, and philanthropy, in addition to expanded drug donation programmes by pharmaceutical companies.[3,5]. To achieve these ambitious aims, WHO issued a roadmap[3] for the control and elimination of neglected tropical diseases, which advocates for expansion of mass drug administration (MDA) to address the large disease burden of helminthiases, including schistosomiasis and soil-transmitted helminthiasis
Added value of this study Our findings suggest that integrated community-wide MDA with high coverage (>75%) and sustained administration (>5 years) against schistosomiasis and soil-transmitted helminthiasis could be crucial in decreasing community disease burden and lowering reinfection
Policy-relevant questions remain about the cost-effectiveness of integrated MDA programmes that might vary substantially in different contexts and settings—eg, when treatment is provided to the entire community, whether elimination of diseases is met or not, administration of different frequencies and treatment coverage, and the varying prevalence and intensities of infection in communities. To address these policyrelevant scenarios, we modelled the cost-effectiveness of MDA strategies for schistosomiasis and soil-transmitted helminthiasis using data from four communities in Côte d’Ivoire and compared integrated, community-wide MDA with treatment of only school-aged children, current WHO guidelines, and other MDA scenarios.[6]
Summary
Evidence before this study We searched PubMed for relevant articles published in English before Aug 22, 2015, using the search terms “helminth” or “schistosomiasis” together with “cost-effectiveness” and “treatment” restricted to the title and abstract fields Ten studies reported about the cost-effectiveness of mass drug administration (MDA) against schistosomiasis or soil-transmitted helminthiasis alone and three studies discussed integrated treatment of schistosomiasis, soil-transmitted helminthiasis, or other diseases. None of these studies evaluated the cost-effectiveness of integrated community-wide MDA against schistosomiasis and soiltransmitted helminthiasis using the disability-adjusted life-year
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