Abstract
In 2019, the Murdoch Children’s Research Institute in partnership with the Fiji Ministry of Health and Medical Services carried out an integrated mass drug administration (MDA) for the treatment of scabies and lymphatic filariasis in the Northern Division of Fiji (population estimate 131,914). We conducted a retrospective micro-costing exercise focused on the cost of scabies control in order to inform budgeting and policy decision making in an endemic setting. We collected detailed information on financial and economic costs incurred by both parties during the course of the MDA campaign (April 2018 to July 2019). We also conducted interviews with personnel involved in the financial administration of the MDA campaign. The economic cost of delivering two doses of ivermectin was US$4.88 per person. The cost of donated drugs accounted for 36.3% of total MDA costs. In this first large-scale MDA for the public health control of scabies, the estimated cost of delivering MDA per person for scabies was considerably more expensive than the costs reported for other neglected tropical diseases. The important cost drivers included the remuneration of health care workers who were extensively involved in the campaign, coverage of hard-to-reach, mainly rural populations and the two-dose regimen of ivermectin. These results highlight the importance of these cost determinants and can be used to plan current and future MDA programs.
Highlights
Scabies is a neglected tropical disease (NTD) caused by the microscopic mite Sarcoptes scabiei var. hominis, and is estimated to affect more than 200 million people globally.[1]
While Big Skin Health Intervention Fiji Trial (SHIFT) was focused on mass drug administration (MDA) for scabies control, during the lead-up to the study in 2018, a transmission assessment survey revealed the prevalence of lymphatic filariasis in the Northern Division was above 1%, necessitating another MDA for control of lymphatic filariasis.[21]
The cost of ivermectin was the largest contributor to the total cost of mass treatment (36.3%), followed by time contributed by MHMS staff (20.5%)
Summary
Scabies is a neglected tropical disease (NTD) caused by the microscopic mite Sarcoptes scabiei var. hominis, and is estimated to affect more than 200 million people globally.[1]. The scratching of skin lesions breaks the skin barrier and can lead to bacterial skin infections such as impetigo, abscesses and cellulitis. Skin and soft tissue infections can in turn lead to more severe complications such as septicemia, kidney disease and possibly, rheumatic heart disease.[2] The economic burden on national health systems due to managing the symptoms of scabies and its secondary complications, along with the impact on productivity as a result of school and work disruptions are considerable.[3,4] Substantial economic costs have been associated with managing scabies outbreaks in several settings.[5,6] individuals affected by scabies can experience social stigma with feelings of shame and embarrassment.[7]
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