Cost-effectiveness of triple drug administration (TDA) with praziquantel, ivermectin and albendazole for the prevention of neglected tropical diseases in Nigeria

Abstract

Onchocerciasis, lymphatic filariasis (LF), schistosomiasis and soil transmitted, helminthiasis (STH) are all coendemic in Nigeria. Annual mass drug administration (MDA) with ivermectin (for onchocerciasis), albendazole (for STH and with ivermectin for LF) and praziquantel (for schistosomiasis) is the WHO-recommended treatment strategy for preventive chemotherapy. Separate delivery rounds for distribution of these drugs have been the usual approach to MDA. All three drugs, however, have now been shown to be clinically and programmatically safe for co-administration with what has come to be known as triple drug administration (TDA). We examined the cost savings of converting from separate delivery rounds to TDA in two states in Nigeria. In 2008, eight local government areas received a single round of ivermectin with albendazole followed at least 1 week later by a single round of praziquantel to school-aged children. The following year, a single round was administered with TDA. The number of treated individuals was essentially unchanged during both years (1 301 864 in 2008 and 1 297 509 in 2009) and no change in adverse events was reported. The total programmatic costs for the MDA, not including drug and overhead costs, reduced by 41% from $123, 624 to $72, 870. Cost savings were limited in larger populations due to economies of scale. TDA is recommended for mature MDA.

A review of soil transmitted helminthiasis in Nigeria

“…These drugs have demonstrated varying egg reduction and curative rates (Table 3). There are increasing reports of mass deworming programme across the country [69,109,110], and studies have suggested that sustainable decrease in infection burden is a result of continuous use of antihelminthics [69,78].…”

Economic and Financial Evaluation of Neglected Tropical Diseases

“…Four studies evaluated the cost-effectiveness of interventions for several NTDs, showing the benefits of combined strategies (Leslie et al, 2011;Evans et al, 2011;Guyatt et al, 2001;Ndeffo Mbah et al, 2013a). All of these studies focussed on African countries; two evaluated real programmes (Leslie et al, 2011;Evans et al, 2011); one modelled the impact on transmission (Ndeffo Mbah et al, 2013b) and one evaluated the effect of deworming on anaemia (Guyatt et al, 2001).…”

“…All of these studies focussed on African countries; two evaluated real programmes (Leslie et al, 2011;Evans et al, 2011); one modelled the impact on transmission (Ndeffo Mbah et al, 2013b) and one evaluated the effect of deworming on anaemia (Guyatt et al, 2001). One evaluated the cost-savings when switching from the separate delivery of three drugs for onchocerciasis, lymphatic filariasis, schistosomiasis and STH MDA to coadministration of the drugs (triple drug administration), which was found to be clinically safe (Evans et al, 2011). Another evaluated programme costs for schistosomiasis and STH control in Niger; cost-effectiveness was evaluated between the start of the intervention (baseline) and the follow-up period (2 years) across eight schools and four communities (Leslie et al, 2011).…”

Preventive chemotherapy for schistosomiasis and soil-transmitted helminthiasis by cotreatment with praziquantel and albendazole

“…Here, it should also be noted that surveillance of schistosomiasis and STH does not operate alone and for it is, or should be, incorporated within the geographical landscape for surveillance of other NTDs, for example for lymphatic filariasis and onchoceriasis [29,45]. This is because for PC treatment associated with the latter two diseases, impacts upon STH, for IVM and ALB taken individually or combined, has tangible impact upon each nematode species [46]. Indeed, the algorithm for PC is illustrated in Figure 2, in which umbrella treatment decisions for lymphatic filariasis and onchocerciasis are part of the treatment decisions tree.…”