Abstract
Gambiense human African trypanosomiasis (gHAT) is marked for elimination of transmission by 2030, but the disease persists in several low-income countries. We couple transmission and health outcomes models to examine the cost-effectiveness of four gHAT elimination strategies in five settings – spanning low- to high-risk – of the Democratic Republic of Congo. Alongside passive screening in fixed health facilities, the strategies include active screening at average or intensified coverage levels, alone or with vector control with a scale-back algorithm when no cases are reported for three consecutive years. In high or moderate-risk settings, costs of gHAT strategies are primarily driven by active screening and, if used, vector control. Due to the cessation of active screening and vector control, most investments (75-80%) are made by 2030 and vector control might be cost-saving while ensuring elimination of transmission. In low-risk settings, costs are driven by passive screening, and minimum-cost strategies consisting of active screening and passive screening lead to elimination of transmission by 2030 with high probability.
Highlights
Gambiense human African trypanosomiasis is marked for elimination of transmission by 2030, but the disease persists in several low-income countries
In 2012, under 15 years after the peak of the last epidemic, Gambiense human African trypanosomiasis (gHAT) was targeted for elimination of transmission (EOT) by 2030, and by 2014 case reduction outpaced the intermediate goals set by the World Health Organization (WHO)[3,13]
The same underlying model framework has been used to examine the epidemiology of gHAT in Democratic Republic of Congo (DRC) and Chad[6,17,22,23,24,25]
Summary
Gambiense human African trypanosomiasis (gHAT) is marked for elimination of transmission by 2030, but the disease persists in several low-income countries. There has been one cost-effectiveness analysis of control and elimination strategies for gHAT, showing that new technologies to facilitate diagnosis, treatment, and curtail vector transmission could make elimination feasible at a moderate costeffectiveness ($400–1500 per disability-adjusted life year (DALY) averted) for high- and medium-transmission settings, but at low cost-effectiveness for low-transmission settings[16]. It is worth reconsidering these questions while taking into account specific, local transmission dynamics, which is possible thanks to recent developments in model calibration[17], and new cost estimates[18,19]. Including realistic levels of screening based on regional data allows us to consider expenses and cost-effectiveness in these real-world settings
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