How much will it cost to eradicate lymphatic filariasis? An analysis of the financial and economic costs of intensified efforts against lymphatic filariasis

Autor: Chris M. Stone, Randee J. Kastner, Fabrizio Tediosi, Elisa Sicuri, Ambrose W. Onapa, Gabriel Matwale
Rok vydání: 2017
Předmět:
Nematoda
Economics
Medicina tropical
Social Sciences
Loa Loa
0302 clinical medicine
Tropical medicine
Economic cost
Medicine and Health Sciences
030212 general & internal medicine
Duration (project management)
Activity-based costing
Lymphatic filariasis
health care economics and organizations
Data Management
Pharmaceutics
lcsh:Public aspects of medicine
Eukaryota
Investment (macroeconomics)
Filariasis
Infectious Diseases
Models
Economic
Helminth Infections
Neglected tropical diseases
Research Article
Neglected Tropical Diseases
Computer and Information Sciences
Drug Administration
lcsh:Arctic medicine. Tropical medicine
lcsh:RC955-962
030231 tropical medicine
macromolecular substances
03 medical and health sciences
Elephantiasis
Filarial
Medicina preventiva
Drug Therapy
medicine
Disease Transmission
Infectious
Parasitic Diseases
Humans
Animals
Disease Eradication
Finance
Preventive medicine
Present value
business.industry
Lymphatic Filariasis
Public Health
Environmental and Occupational Health
Organisms
Tropical disease
Biology and Life Sciences
lcsh:RA1-1270
medicine.disease
Tropical Diseases
Invertebrates
Filaricides
Business
Drug Delivery
Zdroj: Dipòsit Digital de la UB
Universidad de Barcelona
PLoS Neglected Tropical Diseases, Vol 11, Iss 9, p e0005934 (2017)
Recercat. Dipósit de la Recerca de Catalunya
instname
PLoS Neglected Tropical Diseases
Popis: Introduction Lymphatic filariasis (LF), a neglected tropical disease (NTD) preventable through mass drug administration (MDA), is one of six diseases deemed possibly eradicable. Previously we developed one LF elimination scenario, which assumes MDA scale-up to continue in all countries that have previously undertaken MDA. In contrast, our three previously developed eradication scenarios assume all LF endemic countries will undertake MDA at an average (eradication I), fast (eradication II), or instantaneous (eradication III) rate of scale-up. In this analysis we use a micro-costing model to project the financial and economic costs of each of these scenarios in order to provide evidence to decision makers about the investment required to eliminate and eradicate LF. Methodology/Key findings Costing was undertaken from a health system perspective, with all results expressed in 2012 US dollars (USD). A discount rate of 3% was applied to calculate the net present value of future costs. Prospective NTD budgets from LF endemic countries were reviewed to preliminarily determine activities and resources necessary to undertake a program to eliminate LF at a country level. In consultation with LF program experts, activities and resources were further reviewed and a refined list of activities and necessary resources, along with their associated quantities and costs, were determined and grouped into the following activities: advocacy and communication, capacity strengthening, coordination and strengthening partnerships, data management, ongoing surveillance, monitoring and supervision, drug delivery, and administration. The costs of mapping and undertaking transmission assessment surveys and the value of donated drugs and volunteer time were also accounted for. Using previously developed scenarios and deterministic estimates of MDA duration, the financial and economic costs of interrupting LF transmission under varying rates of MDA scale-up were then modelled using a micro-costing approach. The elimination scenario, which includes countries that previously undertook MDA, is estimated to cost 929 million USD (95% Credible Interval: 884m-972m). Proceeding to eradication is anticipated to require a higher financial investment, estimated at 1.24 billion USD (1.17bn-1.30bn) in the eradication III scenario (immediate scale-up), with eradication II (intensified scale-up) projected at 1.27 billion USD (1.21bn-1.33bn), and eradication I (slow scale-up) estimated at 1.29 billion USD (1.23bn-1.34bn). The economic costs of the eradication III scenario are estimated at approximately 7.57 billion USD (7.12bn-7.94bn), while the elimination scenario is projected to have an economic cost of 5.21 billion USD (4.91bn-5.45bn). Countries in the AFRO region will require the greatest investment to reach elimination or eradication, but also stand to gain the most in cost savings. Across all scenarios, capacity strengthening and advocacy and communication represent the greatest financial costs, whereas mapping, post-MDA surveillance, and administration comprise the least. Conclusions/Significance Though challenging to implement, our results indicate that financial and economic savings are greatest under the eradication III scenario. Thus, if eradication for LF is the objective, accelerated scale-up is projected to be the best investment.
Author summary Lymphatic filariasis (LF) is a neglected tropical disease (NTD) that is targeted for elimination and is thought to be potentially eradicable through once yearly mass drug administration (MDA) using drugs that are currently donated to LF endemic countries by the pharmaceutical companies that manufacture them. MDA has proven to be a cost-effective and efficient method of disease control, both for LF and other NTDs. Previously, we developed scale-up scenarios of varying magnitude to reach elimination (elimination of LF in all countries that have previously undertaken MDA) and eradication (local elimination of LF in all LF endemic countries) and estimated the number of associated treatments that would be necessary in each country under each scenario. Here we project the costs—both financial and economic—of each of these scenarios. We use data from a myriad of sources to estimate the cost of various activities, and found that training and advocacy and communication activities comprise the bulk of the costs of the program. Among all scenarios, elimination requires the least total investment. However, in terms of LF eradication, faster rates of MDA scale-up are associated with decreased overall costs.
Databáze: OpenAIRE
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