Integration of deworming into an existing immunisation and vitamin A supplementation campaign is a highly effective approach to maximise health benefits with minimal cost in Lao PDR

Abstract

Infection with soil-transmitted helminths (STHs) is a major public health problem in many developing countries; pregnant women and children are particularly at risk. Preventive chemotherapy (PC) -the intervention currently recommended by the World Health Organization (WHO) against the main helminth infections, including those caused by STHs -aims at reducing morbidity through periodical administration of anthelminthic drugs either alone or in combination.The Expanded Programme on Immunization (EPI) is one of the most widely implemented health programmes in the world and has a well-established access to children and women. The present study investigated the cost of the provision of anthelminthic drugs during existing immunization campaigns.In Lao PDR the use of this integrated approach compared to implementation of the vertical deworming campaign alone allowed reduction of the individual cost of deworming by 10 times (from US$0.25 in the vertical deworming campaign to US$0.02 in the integrated campaign). Burden posed on health workers by the integration process was perceived as minimal and manageable. Besides, delivery of anthelminthic drugs during the immunization campaigns enabled Authors' contributions: All the authors conceived and designed the study; GB conducted the questionnaire survey; GB, PEA, KF, AZ, KP, KS, CC and SP collected the budget data; GB and AY carried out data analysis; GB, AY, AFG, CP and AM interpreted the results of the analysis; GB and AY prepared the draft manuscript, all the authors critically reviewed and gave final approval of the version to be published. AM is the guarantor of the paper. Conflicts of interest: None declared.Ethical approval: As the study was carried out as a part of the vaccination campaign, ethical approval was not required. Informed consent was obtained by all the interviewees prior to the questionnaire survey. Europe PMC Funders Group Europe PMC Funders Author ManuscriptsEurope PMC Funders Author Manuscripts campaign teams to directly observe drug intake, which assured safety. Our findings prove that integration is an opportunity to maximize health benefits through the delivery of multiple health products and the attainment of a high coverage.

Cost and cost-effectiveness of soil-transmitted helminth treatment programmes: systematic review and research needs

“…Seven studies were found to have medium [ 16 , 17 , 19 – 23 ] and only four high [ 24 – 27 ] applicability for the use in economic evaluations. It should be noted that the more in-depth costing studies [ 24 – 27 ] – which also collected economic costs – reported notably higher MDA delivery costs (Table 1 ).…”

“…The three studies identified for programmes targeting only Pre-SAC integrated their distribution either into Child Health Days [ 22 , 28 ] or used mobile teams [ 29 ]. Two studies were identified that investigated the cost of treating women of reproductive age within existing immunisation and vitamin A or iron supplementation campaigns [ 19 , 30 ]. These studies either integrated their distribution into Child Health Days (also targeting Pre-SAC) [ 19 ] or used village health workers [ 30 ].…”

“…The average financial cost per treatment of the vertical schistosomiasis and STH programme (before the NTD programmes integrated) was US$0.10. Medium [ 19 ] Lao PDR STH within an immunisation and vitamin A supplementation campaign Child Health Days Pre SAC and women of child-bearing age (SAC were targeted though the national deworming campaign) Annual N 2009 US$ Y Y The incremental cost of adding deworming into the national immunisation campaign was US$0.03 per treatment (delivery costs: US$0.007). This is compared to US$0.23 per treatment for the vertical national school-based deworming campaign (targeting SAC).…”

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

“…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].…”

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

“…However, they could give an indication of cost savings associated with the integration of mass treatment against NTDs within existing immunization campaigns. [14]…”