Turner, Hugo C., Truscott, James E., Fleming, Fiona M., Hollingsworth, T. Déirdre, Brooker, Simon J. and Anderson, Roy M. (2016) Cost-effectiveness of scaling up mass drug administration for the control of soil-transmitted helminths : a comparison of cost function and constant costs analyses. The Lancet Infectious Diseases, 16 (7). pp. 838-846. doi:10.1016/S1473-3099(15)00268-6 ISSN 1473-3099.

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Abstract

Background:
The coverage of mass drug administration (MDA) for neglected tropical diseases, such as the soil-transmitted helminths (STHs), needs to rapidly expand to meet WHO's 2020 targets. We aimed to compare use of a cost function to take into account economies of scale to the standard method of assuming a constant cost per treatment when investigating the cost and cost-effectiveness of scaling up a STH MDA programme targeting Ascaris lumbricoides.

Methods:
We fitted a cost function describing how the costs of MDA change with scale to empirical cost data and incorporated it into a STH transmission model. Using this cost function, we investigated the consequences of taking into account economies of scale on the projected cost-effectiveness of STH control, by comparison with the standard method of assuming a constant cost per treatment. The cost function was fitted to economic cost data collected as part of a school-based deworming programme in Uganda using maximum likelihood methods. We used the model to investigate the total reduction in the overall worm burden, the total number of prevalent infection case-years averted, and the total number of heavy infection case-years averted. For each year, we calculated the effectiveness as the difference between the worm burden or number of cases and the number in absence of treatment.

Findings:
When using the cost function, the cost-effectiveness of STH control markedly increased as the programme was scaled up. By contrast, the standard method (constant cost per treatment) undervalued this and generated misleading conclusions. For example, when scaling up control in the projected district from 10% to 75% coverage of at-risk school-age children, the cost-effectiveness in terms of prevention of heavy burden infections was projected to increase by over 70% when using the cost function, but decrease by 18% when assuming a constant cost per treatment.

Interpretation:
The current exclusion of economies of scale in most economic analyses must be addressed if the most cost-effective policies for the control of neglected tropical diseases are to be formulated. These findings are also relevant to other large-scale disease interventions.

Item Type:	Journal Article
Subjects:	Q Science > QL Zoology
Divisions:	Faculty of Science, Engineering and Medicine > Science > Life Sciences (2010- ) Faculty of Science, Engineering and Medicine > Science > Mathematics
Library of Congress Subject Headings (LCSH):	Helminths, Soilborne infection
Journal or Publication Title:	The Lancet Infectious Diseases
Publisher:	The Lancet Publishing Group
ISSN:	1473-3099
Official Date:	July 2016
Dates:	Date Event July 2016 Published 17 February 2016 Available 2015 Accepted
Volume:	16
Number:	7
Number of Pages:	9
Page Range:	pp. 838-846
DOI:	10.1016/S1473-3099(15)00268-6
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	24 February 2016
Date of first compliant Open Access:	25 February 2016
Funder:	GlaxoSmithKline, Bill & Melinda Gates Foundation, Imperial College London. Partnership for Child Development, Wellcome Trust (London, England)
Grant number:	OPP1033751 (B&MGF), 098045 (WT)

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