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Vaccination or mass drug administration against schistosomiasis : a hypothetical cost-effectiveness modelling comparison
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Collyer, Benjamin S., Turner, Hugo C., Hollingsworth, T. Déirdre and Keeling, Matthew James (2019) Vaccination or mass drug administration against schistosomiasis : a hypothetical cost-effectiveness modelling comparison. Parasites & Vectors, 12 (1). 499. doi:10.1186/s13071-019-3749-4 ISSN 1756-3305.
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WRAP-vaccination-mass-drug-administration-schistosomiasis-Keeling-2019.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution 4.0. Download (3082Kb) | Preview |
Official URL: https://doi.org/10.1186/s13071-019-3749-4
Abstract
Schistosomiasis is a neglected tropical disease, targeted by the World Health Organization for reduction in morbidity by 2020. It is caused by parasitic flukes that spread through contamination of local water sources. Traditional control focuses on mass drug administration, which kills the majority of adult worms, targeted at school-aged children. However, these drugs do not confer long-term protection and there are concerns over the emergence of drug resistance. The development of a vaccine against schistosomiasis opens the potential for control methods that could generate long-lasting population-level immunity if they are cost-effective. Using an individual-based transmission model, matched to epidemiological data, we compared the cost-effectiveness of a range of vaccination programmes against mass drug administration, across three transmission settings. Health benefit was measured by calculating the heavy-intensity infection years averted by each intervention, while vaccine costs were assessed against robust estimates for the costs of mass drug administration obtained from data. We also calculated a critical vaccination cost, a cost beyond which vaccination might not be economically favorable, by benchmarking the cost-effectiveness of potential vaccines against the cost-effectiveness of mass drug administration, and examined the effect of different vaccine protection durations. We found that sufficiently low-priced vaccines can be more cost-effective than traditional drugs in high prevalence settings, and can lead to a greater reduction in morbidity over shorter time-scales. MDA or vaccination programmes that target the whole community generate the most health benefits, but are generally less cost-effective than those targeting children, due to lower prevalence of schistosomiasis in adults. The ultimate cost-effectiveness of vaccination will be highly dependent on multiple vaccine characteristics, such as the efficacy, cost, safety and duration of protection, as well as the subset of population targeted for vaccination. However, our results indicate that if a vaccine could be developed with reasonable characteristics and for a sufficiently low cost, then vaccination programmes can be a highly cost-effective method of controlling schistosomiasis in high-transmission areas. The population-level immunity generated by vaccination will also inevitably improve the chances of interrupting transmission of the disease, which is the long-term epidemiological goal.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > RC Internal medicine | |||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Science > Life Sciences (2010- ) | |||||||||
| SWORD Depositor: | Library Publications Router | |||||||||
| Library of Congress Subject Headings (LCSH): | Schistosomiasis, Schistosomiasis -- Prevention, Vaccines, Health planning | |||||||||
| Journal or Publication Title: | Parasites & Vectors | |||||||||
| Publisher: | BioMed Central Ltd. | |||||||||
| ISSN: | 1756-3305 | |||||||||
| Official Date: | 23 October 2019 | |||||||||
| Dates: |
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| Volume: | 12 | |||||||||
| Number: | 1 | |||||||||
| Article Number: | 499 | |||||||||
| DOI: | 10.1186/s13071-019-3749-4 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Reuse Statement (publisher, data, author rights): | ** From PubMed via Jisc Publications Router ** History: received 07-05-2019; accepted 11-10-2019. | |||||||||
| Access rights to Published version: | Open Access (Creative Commons) | |||||||||
| Date of first compliant deposit: | 12 November 2019 | |||||||||
| Date of first compliant Open Access: | 18 November 2019 | |||||||||
| RIOXX Funder/Project Grant: |
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