Cost of a new method of active screening for human African trypanosomiasis in the Democratic Republic of the Congo.

Rian Snijders,Filip Meheus,Epco Hasker,Yves Claeys,Erick Miaka,Alain Fukinsia,Alain Mpanya,Marleen Boelaert,Joseph Mathu Ndung'U

doi:10.1371/journal.pntd.0008832

Abstract

BackgroundHuman African trypanosomiases caused by the Trypanosoma brucei gambiense parasite is a lethal disease targeted for eradication. One of the main disease control strategies is active case-finding through outreach campaigns. In 2014, a new method for active screening was developed with mini, motorcycle-based, teams. This study compares the cost of two active case-finding approaches, namely the traditional mobile teams and mini mobile teams, in the two health districts of the Democratic Republic of the Congo.MethodsThe financial and economic costs of both approaches were estimated from a health care provider perspective. Cost and operational data were collected for 12 months for 1 traditional team and 3 mini teams. The cost per person screened and diagnosed was calculated and univariate sensitivity analysis was conducted to identify the main cost drivers.ResultsDuring the study period in total 264,630 people were screened, and 23 HAT cases detected. The cost per person screened was lower for a mini team than for a traditional team in the study setting (US$1.86 versus US$2.08). A comparable result was found in a scenario analysis, assuming both teams would operate in a similar setting, with the cost per person screened by a mini team 15% lower than the cost per person screened by a traditional team (1.86 $ vs 2.14$). The main explanations for this lower cost are that mini teams work with fewer human resources, cheaper means of transportation and do not perform the Capillary Tube Centrifugation test or card agglutination test dilutions.DiscussionActive HAT screening with mini mobile teams has a lower cost and could be a cost-effective alternative for active case-finding. Further research is needed to determine if mini mobile teams have similar or better yields than traditional mobile teams in terms of detections and cases successfully treated.

Highlights

Human African trypanosomiasis (HAT), or sleeping sickness, is a vector-borne disease believed to be invariably fatal when left untreated
Human African Trypanosomiasis (HAT) used to be a major public health problem in Sub-Saharan Africa, but the disease is becoming less frequent as a result of sustained control efforts
A commitment of at least 10 years towards HAT control activities will be necessary with innovative disease control approaches accompanied by economic evaluations to assess their cost and cost-effectiveness in the changing context

Summary

Introduction

Human African trypanosomiasis (HAT), or sleeping sickness, is a vector-borne disease believed to be invariably fatal when left untreated. Infections with T.b. gambiense are responsible for more than 95% of the globally reported HAT cases and are the focus of this study.[1]. Case-finding in the DRC is conducted either actively, through mass outreach campaigns by large 7 to 9 people, truck based mobile teams (here after called ‘traditional teams’) or passively in fixed health facilities. Each of these strategies’ accounts for approximately half of all identified cases. Human African trypanosomiases caused by the Trypanosoma brucei gambiense parasite is a lethal disease targeted for eradication. This study compares the cost of two active case-finding approaches, namely the traditional mobile teams and mini mobile teams, in the two health districts of the Democratic Republic of the Congo

Results

Discussion

Conclusion