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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 
ORCID: https://orcid.org/0000-0001-6915-2588, Crowley, Emily H., 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).
ISSN 1935-2727
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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-effective-ness 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-effective-ness 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: | Article |
|---|---|
| Additional Information: | Data Availability: Information about the data used for fitting is described in Rock et al 2022 (Inf. Dis. of Pov). Screening data in this study were used to inform future potential screening coverage and were obtained through the WHO HAT Atlas, which cannot be shared publicly but is under the stewardship of the WHO and available from the WHO (contact neglected.diseases@who.int or visit https://www.who.int/teams/control-of-neglected-tropical-diseases/human-african-trypanosomiasis/atlas-of-hat) for researchers who meet the criteria for access to confidential data. Assumptions and estimates were parameterized according to conventions in the economic evaluation literature. For assumptions around intervention, treatment effects and costs, see Table 2, S1 Text Section S1.3 and S4 text. Output data derived through the present study and the code to carry out all analyses are available from OSF https://osf.io/bjxwn/. Funding information: This work was supported by the Bill and Melinda Gates Foundation (www.gatesfoundation.org) through the Human African Trypanosomiasis Modelling and Economic Predictions for Policy (HAT MEPP) project [OPP1177824 and INV-005121] (MA, CH, SAS, REC, PEB, XWS, EHC, KSR, and FT) and the Trypa-NO! project [INV-008412 and INV-001785] (PRB, APMS, IT, AP, SB, and PS). The funders of the study did not have any role in the study design, data collection, data analysis, data interpretation, or the composition of the manuscript. |
| Uncontrolled Keywords: | public health, environmental and occupational health,infectious diseases,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2739 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 05 Nov 2024 17:30 |
| Last Modified: | 17 Nov 2024 07:30 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/97523 |
| DOI: | 10.1371/journal.pntd.0011396 |
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