Abstract
BackgroundControl and elimination of zoonotic diseases requires robust information about their effect on both human and livestock health in order to enable policy formulation and the allocation of resources. This study aimed to evaluate the cost-effectiveness of controlling Taenia solium taeniasis/cysticercosis in both humans and pigs, and soil-transmitted helminths (STH) in humans by integrating their control to on-going human and animal health control programmes in northern Lao People’s Democratic Republic.MethodA cross-sectional study was carried out in 49 households, focusing on the prevalence of T. solium taenias/cysticercosis and soil transmitted helminths before and after a twelve month intervention. The village data was collected using a semi-structured questionnaire through a door-to-door survey. The village data was then projected to the wider northern Lao PDR population using stochastic modelling and cost-effectiveness ratio (after aggregating the net cost to capture both human and animal health parameters) and GDP per capita as a threshold, to determine the cost-effectiveness of the integrated control of T. solium taeniasis/ cysticercosis and STH, assuming linear scaling out of the intervention. The zoonotic DALY (zDALY) approach was also used as an alternative method of estimating the cost-effectiveness ratio of controlling T. solium taeniasis/cysticercosis in humans and pigs.FindingsUsing cost-effectiveness analysis after aggregating the net cost and control of T. solium taeniasis/cysticercosis alone as the base case, the study found that simultaneous control of T. solium taeniasis/cysticercosis in humans and pigs, STH in humans and Classical Swine Fever (CSF) in pigs was USD 14 per DALY averted and USD 234 per zDALY averted using zDALY method hence considered highly cost-effective whereas controlling T. solium taeniasis/cysticercosis without incorporating STH and CSF was the least cost-effective (USD 3,672 per DALY averted). Additionally, the cost-effectiveness of controlling T. solium taeniasis/cysticercosis in people and pigs using zDALY as an alternative method was USD 3,662 per zDALY averted which was quite close to our findings using the aggregate net cost method.ConclusionThe study showed that control of T. solium taeniasis/cysticercosis alone in humans and pigs is not cost-effective in northern Lao PDR whereas control of STH is. Consequently, integrating T. solium taeniasis/cysticercosis control with other cost-effective programmes such as STH and CSF markedly improved the cost-effectiveness of the intervention. This is especially important in low resource countries where control of zoonotic neglected tropical diseases could be integrated with the human and animal health sectors to optimize use of the limited resources.Trial registrationAustralia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12614001067662.
Highlights
Taenia solium taeniasis-cysticercosis complex is a zoonotic Neglected Tropical Disease found throughout many parts of Asia, Africa and Latin America, where pigs and humans co-exist in areas of poor sanitation and hygiene [1,2]
The study showed that control of T. solium taeniasis/cysticercosis alone in humans and pigs is not cost-effective in northern Lao PDR whereas control of soil-transmitted helminths (STH) is
Integrating T. solium taeniasis/cysticercosis control with other cost-effective programmes such as STH and Classical Swine Fever (CSF) markedly improved the cost-effectiveness of the intervention
Summary
Taenia solium taeniasis-cysticercosis complex is a zoonotic Neglected Tropical Disease (zNTD) found throughout many parts of Asia, Africa and Latin America, where pigs and humans co-exist in areas of poor sanitation and hygiene [1,2]. There is broad consensus that the economic analysis of zoonoses control programmes should be based on a holistic measurement of ‘total societal benefits’ as compared to calculating the total costs of controlling disease in humans and in animal reservoirs [6]. This requires an understanding of the level of integration [7,8] and comprehensive economics metrics to compare cost-effective control methods [9]. This study aimed to evaluate the cost-effectiveness of controlling Taenia solium taeniasis/cysticercosis in both humans and pigs, and soil-transmitted helminths (STH) in humans by integrating their control to on-going human and animal health control programmes in northern Lao People’s Democratic Republic.
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