Health economic evaluation of strategies to eliminate gambiense human African trypanosomiasis in the Mandoul disease focus of Chad.

Autor: Antillon M; Swiss Tropical and Public Health Institute, Basel, Switzerland.; University of Basel, Basel, Switzerland., Huang CI; Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom.; Mathematics Institute, The University of Warwick, Coventry, United Kingdom., Sutherland SA; Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom.; Warwick Medical School, University of Warwick, Coventry, United Kingdom., Crump RE; Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom.; Mathematics Institute, The University of Warwick, Coventry, United Kingdom., Bessell PR; Independent Consultant, Edinburgh, United Kingdom., Shaw APM; Infection Medicine, Deanery of Biomedical Sciences, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom.; AP Consultants, Walworth Enterprise Centre, Andover, United Kingdom., Tirados I; Department of Vector Biology, Liverpool School of Tropical Medicine, United Kingdom., Picado A; Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland., Biéler S; Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland., Brown PE; Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom.; Mathematics Institute, The University of Warwick, Coventry, United Kingdom., Solano P; Institut de Recherche pour le Développement, UMR INTERTRYP IRD-CIRAD, Université de Montpellier, Montpellier, France., Mbainda S; Programme National de Lutte contre la Trypanosomiase Humaine Africaine (PNLTHA), Moundou, Chad., Darnas J; Programme National de Lutte contre la Trypanosomiase Humaine Africaine (PNLTHA), Moundou, Chad., Wang-Steverding X; Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom.; Warwick Medical School, University of Warwick, Coventry, United Kingdom., Crowley EH; Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom.; Mathematics Institute, The University of Warwick, Coventry, United Kingdom., Peka M; Programme National de Lutte contre la Trypanosomiase Humaine Africaine (PNLTHA), Moundou, Chad., Tediosi F; Swiss Tropical and Public Health Institute, Basel, Switzerland.; University of Basel, Basel, Switzerland., Rock KS; Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research, The University of Warwick, Coventry, United Kingdom.; Mathematics Institute, The University of Warwick, Coventry, United Kingdom.
Jazyk: angličtina
Zdroj: PLoS neglected tropical diseases [PLoS Negl Trop Dis] 2023 Jul 27; Vol. 17 (7), pp. e0011396. Date of Electronic Publication: 2023 Jul 27 (Print Publication: 2023).
DOI: 10.1371/journal.pntd.0011396
Abstrakt: 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.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2023 Antillon et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje