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Health economic evaluation of strategies to eliminate gambiense human African trypanosomiasis in the Mandoul disease focus of Chad
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Antillon, Marina, Huang, Ching-I, Sutherland, Samuel A., Crump, Ronald E., Bessell, Paul R., Shaw, Alexandra P. M., Tirados, Iñaki, Picado, Albert, Biéler, Sylvain, Brown, Paul E., Solano, Philippe, Mbainda, Severin, Darnas, Justin, Wang-Steverding, Xia, Crowley, Emily, Peka, Mallaye, Tediosi, Fabrizio and Rock, Kat S. (2023) Health economic evaluation of strategies to eliminate gambiense human African trypanosomiasis in the Mandoul disease focus of Chad. PLOS Neglected Tropical Diseases, 17 (7). e0011396. doi:10.1371/journal.pntd.0011396 ISSN 1935-2735.
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Official URL: https://doi.org/10.1371/journal.pntd.0011396
Abstract
Human African trypanosomiasis, caused by the gambiense subspecies of Trypanosoma brucei (gHAT), is a deadly parasitic disease transmitted by tsetse. Partners worldwide have stepped up efforts to eliminate the disease, and the Chadian government has focused on the previously high-prevalence setting of Mandoul. In this study, we evaluate the economic efficiency of the intensified strategy that was put in place in 2014 aimed at interrupting the transmission of gHAT, and we make recommendations on the best way forward based on both epidemiological projections and cost-effectiveness. In our analysis, we use a dynamic transmission model fit to epidemiological data from Mandoul to evaluate the cost-effectiveness of combinations of active screening, improved passive screening (defined as an expansion of the number of health posts capable of screening for gHAT), and vector control activities (the deployment of Tiny Targets to control the tsetse vector). For cost-effectiveness analyses, our primary outcome is disease burden, denominated in disability-adjusted life-years (DALYs), and costs, denominated in 2020 US$. Although active and passive screening have enabled more rapid diagnosis and accessible treatment in Mandoul, the addition of vector control provided good value-for-money (at less than $750/DALY averted) which substantially increased the probability of reaching the 2030 elimination target for gHAT as set by the World Health Organization. Our transmission modelling and economic evaluation suggest that the gains that have been made could be maintained by passive screening. Our analysis speaks to comparative efficiency, and it does not take into account all possible considerations; for instance, any cessation of ongoing active screening should first consider that substantial surveillance activities will be critical to verify the elimination of transmission and to protect against the possible importation of infection from neighbouring endemic foci.
| Item Type: | Journal Article | ||||||
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| Divisions: | Faculty of Science, Engineering and Medicine > Science > Mathematics Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| SWORD Depositor: | Library Publications Router | ||||||
| Journal or Publication Title: | PLOS Neglected Tropical Diseases | ||||||
| Publisher: | Public Library of Science | ||||||
| ISSN: | 1935-2735 | ||||||
| Official Date: | 27 July 2023 | ||||||
| Dates: |
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| Volume: | 17 | ||||||
| Number: | 7 | ||||||
| Article Number: | e0011396 | ||||||
| DOI: | 10.1371/journal.pntd.0011396 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||
| Date of first compliant deposit: | 25 August 2023 | ||||||
| Date of first compliant Open Access: | 25 August 2023 | ||||||
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| Contributors: |
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