Abstract
Schistosomiasis japonica remains a significant public-health problem in China. This study evaluated cost-effectiveness of a comprehensive schistosomiasis control program (2003–2006). The comprehensive control program was implemented in Zhangjia and Jianwu (cases); while standard interventions continued in Koutou and Xiajia (controls). Incurred costs were documented and the schistosomiasis comprehensive impact index (SCI) and cost-effectiveness ratio (Comprehensive Control Program Cost/SCI) were applied. In 2003, prevalence of Schistosoma japonicum infection was 11.3% (Zhangjia), 6.7% (Jianwu), 6.5% (Koutou), and 8.0% (Xiajia). In 2006, the comprehensive control program in Zhangjia and Jianwu reduced infection to 1.6% and 0.6%, respectively; while Koutou and Xiajia had a schistosomiasis prevalence of 3.2% and 13.0%, respectively. The year-by-year SCIs in Zhangjia were 0.28, 105.25, and 47.58, with an overall increase in cost-effectiveness ratio of 374.9%–544.8%. The SCIs in Jianwu were 16.21, 52.95, and 149.58, with increase in cost-effectiveness of 226.7%–1,149.4%. Investment in Koutou and Xiajia remained static (US$10,000 unit cost). The comprehensive control program implemented in the two case villages reduced median prevalence of schistosomiasis 8.5-fold. Further, the cost effectiveness ratio demonstrated that the comprehensive control program was 170% (Zhangjia) and 922.7% (Jianwu) more cost-effective. This work clearly shows the improvements in both cost and disease prevention effectiveness that a comprehensive control program-approach has on schistosomiasis infection prevalence.
Highlights
Over the past sixty years, Schistosomiasis japonicum control efforts have resulted in significant disease reduction across China, as evidenced by the Report of Schistosomiasis Status in China which estimated 412,927, 365,770, 325,825, and 286,386 cases per year for 2008–2011, respectively.schistosomiasis remains a significant and costly public health issue along the lower reaches of the Yangtze River Basin and in some mountainous regions of Yunnan and Sichuan Province.Additional provinces where schistosomiasis remains endemic include Hunan, Hubei, Anhui, Jiangxi and Jiangsu
Applying this control methodology resulted in reductions of overall prevalence of schistosomiasis infection [5,6,7,8]; since the early twenty-first century, many ―comprehensive‖ control programs have been implemented on a trial basis in endemic areas of China, while in other areas the standard chemotherapy/snail reduction programs continue, even today
Prior to the implementation of the Comprehensive Program in Zhangjia and Jianwu, a baseline survey was performed in all four study villages in Year 1 of the study
Summary
Over the past sixty years, Schistosomiasis japonicum control efforts have resulted in significant disease reduction across China, as evidenced by the Report of Schistosomiasis Status in China which estimated 412,927, 365,770, 325,825, and 286,386 cases per year for 2008–2011, respectively.schistosomiasis remains a significant and costly public health issue along the lower reaches of the Yangtze River Basin and in some mountainous regions of Yunnan and Sichuan Province.Additional provinces where schistosomiasis remains endemic include Hunan, Hubei, Anhui, Jiangxi and Jiangsu. When the drug praziquantel was introduced in the 1980s, schistosomiasis mitigation efforts shifted to chemotherapy-based morbidity control, supplemented with local snail reduction using niclosamide. Applying this control methodology resulted in reductions of overall prevalence of schistosomiasis infection [5,6,7,8]; since the early twenty-first century, many ―comprehensive‖ control programs have been implemented on a trial basis in endemic areas of China, while in other areas the standard chemotherapy/snail reduction programs continue, even today.
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