Costs of Integrated Mass Drug Administration for Neglected Tropical Diseases in Haiti

Goldman, Ann S.; Brady, Molly; Direny, Abdel; Desir, Luccene; Oscard, Roland; Vely, Jean-Francois; Linehan, Mary; Baker, Margaret

doi:10.4269/ajtmh.2011.10-0635

Cited by 22 publications

(31 citation statements)

References 5 publications

(4 reference statements)

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“…Baseline MDA scenarios assumed the use of albendazole (with an economic cost of $0.50 per treated child in school-based programs[14, 32-35]) and a coverage rate of 56.2% of school-aged children, following the current reported rate in Brazil[36]. The baseline vaccination scenario assumed the criteria described in the human hookworm vaccine's target product profile (TPP)[37].…”

Section: Methodsmentioning

confidence: 99%

“…We varied vaccine efficacy (20% to 80%), duration of protection (5 to 20 years), vaccination coverage of infants (75% to 97%), probability of getting a booster in adulthood (60% to 78%), MDA coverage of school-aged children (56.2% to 75%, following the WHO's 2020 coverage goal[38]), the cost of MDA per child treated ($0.21[34] to $0.79[35]), and the vaccination cost per dose ($0.50 to $2). Additional sensitivity analysis varied the disability weights utilized from the Global Burden of Disease 2004 to 2010 estimates (Table 1).…”

Section: Methodsmentioning

confidence: 99%

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Modeling the economic and epidemiologic impact of hookworm vaccine and mass drug administration (MDA) in Brazil, a high transmission setting

Bartsch

Hotez

Hertenstein

et al. 2016

Vaccine

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Background Although mass drug administration (MDA) has helped reduce morbidity attributed to soil-transmitted helminth infections in children, its limitations for hookworm infection have motivated the development of a human hookworm vaccine to both improve morbidity control and ultimately help block hookworm transmission leading to elimination. However, the potential economic and epidemiologic impact of a preventive vaccine has not been fully evaluated. Methods We developed a dynamic compartment model coupled to a clinical and economics outcomes model representing both the human and hookworm populations in a high transmission region of Brazil. Experiments simulated different implementation scenarios of MDA and vaccination under varying circumstances. Results Considering only intervention costs, both annual MDA and vaccination were highly cost-effective (ICERs ≤$790/DALY averted) compared to no intervention, with vaccination resulting in lower incremental cost-effectiveness ratios (ICERs ≤$444/DALY averted). From the societal perspective, vaccination was economically dominant (i.e., less costly and more effective) than annual MDA in all tested scenarios, except when vaccination was less efficacious (20% efficacy, 5 year duration) and MDA coverage was 75%. Increasing the vaccine's duration of protection and efficacy, and including a booster injection in adulthood all increased the benefits of vaccination (i.e., resulted in lower hookworm prevalence, averted more disability-adjusted life years, and saved more costs). Assuming its target product profile, a pediatric hookworm vaccine drastically decreased hookworm prevalence in children to 14.6% after 20 years, compared to 57.2% with no intervention and 54.1% with MDA. The addition of a booster in adulthood further reduced the overall prevalence from 68.0% to 36.0%, nearly eliminated hookworm infection in children. Conclusion Using a human hookworm vaccine would be cost-effective and in many cases economically dominant, providing both health benefits and cost-savings. It could become a key technology in effecting control and elimination efforts for hookworm globally.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Modeling the economic and epidemiologic impact of hookworm vaccine and mass drug administration (MDA) in Brazil, a high transmission setting

Bartsch

Hotez

Hertenstein

et al. 2016

Vaccine

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“…Of the 34 studies identified in our review, only 8 referred explicitly to eradication (yaws) or elimination (LF, onchocerciasis) as a programme objective. [11][15][16][17][18][19][20][21] Only one of those directly compared the costs of control and elimination strategies (for onchocerciasis), involving annual and biannual (twice yearly) mass treatment respectively; the difference is determined by the number of rounds rather than by so-called “last mile” costs. [21]…”

Section: Discussionmentioning

confidence: 99%

Benchmarking the Cost per Person of Mass Treatment for Selected Neglected Tropical Diseases: An Approach Based on Literature Review and Meta-regression with Web-Based Software Application

et al. 2016

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BackgroundAdvocacy around mass treatment for the elimination of selected Neglected Tropical Diseases (NTDs) has typically put the cost per person treated at less than US$ 0.50. Whilst useful for advocacy, the focus on a single number misrepresents the complexity of delivering “free” donated medicines to about a billion people across the world. We perform a literature review and meta-regression of the cost per person per round of mass treatment against NTDs. We develop a web-based software application (https://healthy.shinyapps.io/benchmark/) to calculate setting-specific unit costs against which programme budgets and expenditures or results-based pay-outs can be benchmarked.MethodsWe reviewed costing studies of mass treatment for the control, elimination or eradication of lymphatic filariasis, schistosomiasis, soil-transmitted helminthiasis, onchocerciasis, trachoma and yaws. These are the main 6 NTDs for which mass treatment is recommended. We extracted financial and economic unit costs, adjusted to a standard definition and base year. We regressed unit costs on the number of people treated and other explanatory variables. Regression results were used to “predict” country-specific unit cost benchmarks.ResultsWe reviewed 56 costing studies and included in the meta-regression 34 studies from 23 countries and 91 sites. Unit costs were found to be very sensitive to economies of scale, and the decision of whether or not to use local volunteers. Financial unit costs are expected to be less than 2015 US$ 0.50 in most countries for programmes that treat 100 thousand people or more. However, for smaller programmes, including those in the “last mile”, or those that cannot rely on local volunteers, both economic and financial unit costs are expected to be higher.DiscussionThe available evidence confirms that mass treatment offers a low cost public health intervention on the path towards universal health coverage. However, more costing studies focussed on elimination are needed. Unit cost benchmarks can help in monitoring value for money in programme plans, budgets and accounts, or in setting a reasonable pay-out for results-based financing mechanisms.

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“…The challenge of integrating multiple disease-specific control programs—here interpreted primarily as enabling programs to carry out similar activities in a most efficient and cost-effective manner—is one that has been taken up enthusiastically by WHO and the national programs supported by the USAID NTD Control Program 1,8,14–18. Because past experience with such integration was largely anecdotal, it was one of the principal aims of the NTD Control Program to identify empirically the most effective and efficient strategies that could later be used to inform other programs also seeking to integrate their NTD activities.…”

Section: Discussionmentioning

confidence: 99%

Integrated Implementation of Programs Targeting Neglected Tropical Diseases through Preventive Chemotherapy: Identifying Best Practices to Roll Out Programs at National Scale

Hanson¹,

Weaver²,

Zoerhoff³

et al. 2012

The American Society of Tropical Medicine and Hygiene

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Abstract. In 2006 the U.S. Agency for International Development (USAID) established the Neglected Tropical Disease (NTD) Control Program to support national governments in developing successful, cost-efficient NTD programs that integrate disease-specific programs into coordinated national initiatives, in accord with the World Health Organization recommendations. A 3-stage "roll-out package" has been developed for effectively integrating and scaling up such programs to full-national scale. Stage-1 lays the groundwork-identifying NTD leadership within the Ministry of Health, conducting a national Situation Analysis, formulating a multiyear Plan of Action, and undertaking a funding gap analysis. Stage-2 focuses on scaling up the integrated NTD program-convening national stakeholder meetings, developing annual work plans, carrying out disease mapping, and establishing monitoring and evaluation activities. Stage-3 aims at ensuring effective management-identifying clear roles and responsibilities for partners, and creating a central coordinating mechanism. Assessment and reassessment of these complex NTD programs that target literally billions of people are essential to establish "best practice" strategies for long-term public health success.

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Costs of Integrated Mass Drug Administration for Neglected Tropical Diseases in Haiti

Cited by 22 publications

References 5 publications

Modeling the economic and epidemiologic impact of hookworm vaccine and mass drug administration (MDA) in Brazil, a high transmission setting

Modeling the economic and epidemiologic impact of hookworm vaccine and mass drug administration (MDA) in Brazil, a high transmission setting

Benchmarking the Cost per Person of Mass Treatment for Selected Neglected Tropical Diseases: An Approach Based on Literature Review and Meta-regression with Web-Based Software Application

Integrated Implementation of Programs Targeting Neglected Tropical Diseases through Preventive Chemotherapy: Identifying Best Practices to Roll Out Programs at National Scale

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