Different approaches to modelling the cost-effectiveness of schistosomiasis control

Guyatt, Helen

doi:10.1590/s0074-02761998000700010

Cited by 23 publications

(13 citation statements)

References 9 publications

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“…This means that it is likely that at least some of the morbidity in adults will not be resolved by treatment - as it may be a consequence of the infection burden they had throughout childhood. Previous modelling studies have successfully captured trends in morbidity data using functions which relate morbidity to the accumulated past experience of infection [53–57]. The 2010 GBD study now includes separate calculations for the more advanced forms of schistosomiasis-related morbidity, such as hepatic inflammation, hematemesis, and ascites [58].…”

Section: Discussionmentioning

confidence: 99%

Evaluating the variation in the projected benefit of community-wide mass treatment for schistosomiasis: Implications for future economic evaluations

et al. 2017

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BackgroundThe majority of schistosomiasis control programmes focus on targeting school-aged children. Expanding the use of community-wide mass treatment to reach more adults is under consideration. However, it should be noted that this would require a further increase in programmatic resources, international aid, and commitment for the provision of praziquantel. Consequently, it is important to understand (i) where a change of strategy would have the greatest benefit, and (ii) how generalisable the conclusions of field trials and analytical studies based on mathematical models investigating the impact of community-wide mass treatment, are to a broad range of settings.MethodsIn this paper, we employ a previously described deterministic fully age-structured schistosomiasis transmission model and evaluate the benefit of community-wide mass treatment both in terms of controlling morbidity and eliminating transmission for Schistosoma mansoni, across a wide range of epidemiological settings and programmatic scenarios. This included variation in the baseline relative worm pre-control burden in adults, the overall level of transmission in defined settings, choice of effectiveness metric (basing morbidity calculations on prevalence or intensity), the level of school enrolment and treatment compliance.ResultsCommunity-wide mass treatment was found to be more effective for controlling the transmission of schistosome parasites than using a school-based programme only targeting school-aged children. However, in the context of morbidity control, the potential benefit of switching to community-wide mass treatment was highly variable across the different scenarios analysed. In contrast, for areas where the goal is to eliminate transmission, the projected benefit of community-wide mass treatment was more consistent.ConclusionWhether community-wide mass treatment is appropriate will depend on the local epidemiological setting (i.e. the relative pre-control burden in adults and transmission intensity), and whether the goal is morbidity control or eliminating transmission. This has important implications regarding the generalisability of cost-effectiveness analyses of schistosomiasis interventions. Our results indicate that areas with poor school-enrolment/coverage could benefit more from community-wide treatment of praziquantel and should potentially be prioritised for any change in strategy. This work highlights the importance of not over-generalising conclusions and policy in this area, but of basing decisions on high quality epidemiological data and quantitative analyses of the impact of interventions in a range of settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s13071-017-2141-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Evaluating the variation in the projected benefit of community-wide mass treatment for schistosomiasis: Implications for future economic evaluations

et al. 2017

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“…Dynamic models predict rates of re‐infection over fixed time intervals, and provide estimates of infections, heavy infections and morbidity cases prevented each year. These predictions, which will require validation, will assist in quantifying the impact of control on disease burden, and thereby in evaluating the cost‐effectiveness of control (Guyatt 1998).…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and geography of Schistosoma mansoni in Uganda: implications for planning control

Kabatereine

Brooker

Tukahebwa

et al. 2004

Tropical Med Int Health

198

196

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SummaryIntestinal schistosomiasis caused by infection with Schistosoma mansoni is a widespread public health problem in Uganda. Although long known to be endemic, its current distribution within the country requires updating of parasitological data to help guide planned control. We report such data collected between 1998 and 2002 from 201 schools and 68 communities across Uganda. In accordance with epidemiological expectation, prevalence and intensity increased with age, peaking at 10-20 years and thereafter declined moderately with age, whereas intensity declined more rapidly with age, and the prevalence of infection in a school was non-linearly related to the mean intensity of infection. We used geographical information systems to map the distribution of infection and to overlay parasitological data with interpolated environmental surfaces. The derived maps indicate both a widespread occurrence of infection and a marked variability in infection prevalence, with prevalence typically highest near the lakeshore and along large rivers. No transmission occurred at altitudes >1400 m or where total annual rainfall was <900 mm; limits which can help estimate the population at risk of schistosomiasis. The results are discussed in reference to the ecology of infection and provide an epidemiological framework for the design and implementation of control efforts underway in Uganda.

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“…For example, Prescott noted that in sub-Saharan Africa the reduction in costs of praziquantel influenced the ranking of S. haematobium infection control measures. Following, a static model and two dynamic models to assess the cost-effectiveness of schistosomiasis control were reviewed [22,23]. In China, a similar assessment was initiated in the early 1990s [24,25].…”

Section: Resultsmentioning

confidence: 99%

Impact and Cost-Effectiveness of a Comprehensive Schistosomiasis japonica Control Program in the Poyang Lake Region of China

Zhao

Hong³

et al. 2013

IJERPH

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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.

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Different approaches to modelling the cost-effectiveness of schistosomiasis control

Cited by 23 publications

References 9 publications

Evaluating the variation in the projected benefit of community-wide mass treatment for schistosomiasis: Implications for future economic evaluations

Evaluating the variation in the projected benefit of community-wide mass treatment for schistosomiasis: Implications for future economic evaluations

Epidemiology and geography of Schistosoma mansoni in Uganda: implications for planning control

Impact and Cost-Effectiveness of a Comprehensive Schistosomiasis japonica Control Program in the Poyang Lake Region of China

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