Modelling the health impact and cost-effectiveness of lymphatic filariasis eradication under varying levels of mass drug administration scale-up and geographic coverage
Identifieur interne : 003B77 ( Pmc/Curation ); précédent : 003B76; suivant : 003B78Modelling the health impact and cost-effectiveness of lymphatic filariasis eradication under varying levels of mass drug administration scale-up and geographic coverage
Auteurs : Christopher M. Stone [Suisse, États-Unis] ; Randee Kastner [Suisse] ; Peter Steinmann [Suisse] ; Nakul Chitnis [Suisse] ; Marcel Tanner [Suisse] ; Fabrizio Tediosi [Suisse]Source :
- BMJ Global Health [ 2059-7908 ] ; 2016.
Abstract
A global programme to eliminate lymphatic filariasis (GPELF) is underway, yet two key programmatic features are currently still lacking: (1) the extension of efforts to all lymphatic filariasis (LF) endemic countries, and (2) the expansion of geographic coverage of mass drug administration (MDA) within countries. For varying levels of scale-up of MDA, we assessed the health benefits and the incremental cost-effectiveness ratios (ICERs) associated with LF eradication, projected the potential savings due to decreased morbidity management needs, and estimated potential household productivity gains as a result of reduced LF-related morbidity.
We extended an LF transmission model to track hydrocele and lymphoedema incidence in order to obtain estimates of the disability adjusted life years (DALYs) averted due to scaling up MDA over a period of 50 years. We then estimated the ICERs and the cost-effectiveness acceptability curves associated with different rates of MDA scale-up. Health systems savings were estimated by considering the averted morbidity, treatment-seeking behaviour and morbidity management costs. Gains in worker productivity were estimated by multiplying estimated working days lost as a result of morbidity with country-specific per-worker agricultural wages.
Our projections indicate that a massive scaling-up of MDA could lead to 4.38 million incremental DALYs averted over a 50-year time horizon compared to a scenario which mirrors current efforts against LF. In comparison to maintaining the current rate of progress against LF, massive scaling-up of MDA—pursuing LF eradication as soon as possible—was most likely to be cost-effective above a willingness to pay threshold of US$71.5/DALY averted. Intensified MDA scale-up was also associated with lower ICERs. Furthermore, this could result in health systems savings up to US$483 million. Extending coverage to all endemic areas could generate additional economic benefits through gains in worker productivity between US$3.4 and US$14.4 billion.
In addition to ethical and political motivations for scaling-up MDA rapidly, this analysis provides economic support for increasing the intensity of MDA programmes.
Url:
DOI: 10.1136/bmjgh-2015-000021
PubMed: 28588916
PubMed Central: 5321305
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>A global programme to eliminate lymphatic filariasis (GPELF) is underway, yet two key programmatic features are currently still lacking: (1) the extension of efforts to all lymphatic filariasis (LF) endemic countries, and (2) the expansion of geographic coverage of mass drug administration (MDA) within countries. For varying levels of scale-up of MDA, we assessed the health benefits and the incremental cost-effectiveness ratios (ICERs) associated with LF eradication, projected the potential savings due to decreased morbidity management needs, and estimated potential household productivity gains as a result of reduced LF-related morbidity.</p>
</sec>
<sec><title>Methods</title>
<p>We extended an LF transmission model to track hydrocele and lymphoedema incidence in order to obtain estimates of the disability adjusted life years (DALYs) averted due to scaling up MDA over a period of 50 years. We then estimated the ICERs and the cost-effectiveness acceptability curves associated with different rates of MDA scale-up. Health systems savings were estimated by considering the averted morbidity, treatment-seeking behaviour and morbidity management costs. Gains in worker productivity were estimated by multiplying estimated working days lost as a result of morbidity with country-specific per-worker agricultural wages.</p>
</sec>
<sec><title>Results</title>
<p>Our projections indicate that a massive scaling-up of MDA could lead to 4.38 million incremental DALYs averted over a 50-year time horizon compared to a scenario which mirrors current efforts against LF. In comparison to maintaining the current rate of progress against LF, massive scaling-up of MDA—pursuing LF eradication as soon as possible—was most likely to be cost-effective above a willingness to pay threshold of US$71.5/DALY averted. Intensified MDA scale-up was also associated with lower ICERs. Furthermore, this could result in health systems savings up to US$483 million. Extending coverage to all endemic areas could generate additional economic benefits through gains in worker productivity between US$3.4 and US$14.4 billion.</p>
</sec>
<sec><title>Conclusions</title>
<p>In addition to ethical and political motivations for scaling-up MDA rapidly, this analysis provides economic support for increasing the intensity of MDA programmes.</p>
</sec>
</div>
</front>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">BMJ Glob Health</journal-id>
<journal-id journal-id-type="iso-abbrev">BMJ Glob Health</journal-id>
<journal-id journal-id-type="hwp">bmjgh</journal-id>
<journal-id journal-id-type="publisher-id">bmjgh</journal-id>
<journal-title-group><journal-title>BMJ Global Health</journal-title>
</journal-title-group>
<issn pub-type="epub">2059-7908</issn>
<publisher><publisher-name>BMJ Publishing Group</publisher-name>
<publisher-loc>BMA House, Tavistock Square, London, WC1H 9JR</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">28588916</article-id>
<article-id pub-id-type="pmc">5321305</article-id>
<article-id pub-id-type="publisher-id">bmjgh-2015-000021</article-id>
<article-id pub-id-type="doi">10.1136/bmjgh-2015-000021</article-id>
<article-categories><subj-group subj-group-type="hwp-journal-coll"><subject>1506</subject>
</subj-group>
<subj-group subj-group-type="heading"><subject>Research</subject>
</subj-group>
</article-categories>
<title-group><article-title>Modelling the health impact and cost-effectiveness of lymphatic filariasis eradication under varying levels of mass drug administration scale-up and geographic coverage</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Stone</surname>
<given-names>Christopher M</given-names>
</name>
<xref ref-type="aff" rid="af1">1</xref>
<xref ref-type="aff" rid="af2">2</xref>
<xref ref-type="aff" rid="af3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kastner</surname>
<given-names>Randee</given-names>
</name>
<xref ref-type="aff" rid="af1">1</xref>
<xref ref-type="aff" rid="af2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Steinmann</surname>
<given-names>Peter</given-names>
</name>
<xref ref-type="aff" rid="af1">1</xref>
<xref ref-type="aff" rid="af2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Chitnis</surname>
<given-names>Nakul</given-names>
</name>
<xref ref-type="aff" rid="af1">1</xref>
<xref ref-type="aff" rid="af2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tanner</surname>
<given-names>Marcel</given-names>
</name>
<xref ref-type="aff" rid="af1">1</xref>
<xref ref-type="aff" rid="af2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tediosi</surname>
<given-names>Fabrizio</given-names>
</name>
<xref ref-type="aff" rid="af1">1</xref>
<xref ref-type="aff" rid="af2">2</xref>
</contrib>
</contrib-group>
<aff id="af1"><label>1</label>
<institution>Swiss Tropical and Public Health Institute</institution>
,<addr-line>Basel</addr-line>
,<country>Switzerland</country>
</aff>
<aff id="af2"><label>2</label>
<institution>Universität Basel</institution>
,<addr-line>Basel</addr-line>
,<country>Switzerland</country>
</aff>
<aff id="af3"><label>3</label>
<addr-line>Department of Statistics</addr-line>
,<institution>North Carolina State University</institution>
,<addr-line>Raleigh, North Carolina</addr-line>
,<country>USA</country>
.</aff>
<author-notes><corresp><label>Correspondence to</label>
Dr Fabrizio Tediosi; <email>Fabrizio.Tediosi@unibas.ch</email>
</corresp>
</author-notes>
<pub-date pub-type="collection"><month>4</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="epub"><day>6</day>
<month>4</month>
<year>2016</year>
</pub-date>
<volume>1</volume>
<issue>1</issue>
<elocation-id>e000021</elocation-id>
<history><date date-type="received"><day>8</day>
<month>12</month>
<year>2015</year>
</date>
<date date-type="rev-recd"><day>15</day>
<month>1</month>
<year>2016</year>
</date>
<date date-type="accepted"><day>21</day>
<month>1</month>
<year>2016</year>
</date>
</history>
<permissions><copyright-statement>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/</copyright-statement>
<copyright-year>2016</copyright-year>
<license license-type="open-access"><license-p>This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>
</license-p>
</license>
</permissions>
<self-uri xlink:title="pdf" xlink:href="bmjgh-2015-000021.pdf"></self-uri>
<abstract><sec><title>Background</title>
<p>A global programme to eliminate lymphatic filariasis (GPELF) is underway, yet two key programmatic features are currently still lacking: (1) the extension of efforts to all lymphatic filariasis (LF) endemic countries, and (2) the expansion of geographic coverage of mass drug administration (MDA) within countries. For varying levels of scale-up of MDA, we assessed the health benefits and the incremental cost-effectiveness ratios (ICERs) associated with LF eradication, projected the potential savings due to decreased morbidity management needs, and estimated potential household productivity gains as a result of reduced LF-related morbidity.</p>
</sec>
<sec><title>Methods</title>
<p>We extended an LF transmission model to track hydrocele and lymphoedema incidence in order to obtain estimates of the disability adjusted life years (DALYs) averted due to scaling up MDA over a period of 50 years. We then estimated the ICERs and the cost-effectiveness acceptability curves associated with different rates of MDA scale-up. Health systems savings were estimated by considering the averted morbidity, treatment-seeking behaviour and morbidity management costs. Gains in worker productivity were estimated by multiplying estimated working days lost as a result of morbidity with country-specific per-worker agricultural wages.</p>
</sec>
<sec><title>Results</title>
<p>Our projections indicate that a massive scaling-up of MDA could lead to 4.38 million incremental DALYs averted over a 50-year time horizon compared to a scenario which mirrors current efforts against LF. In comparison to maintaining the current rate of progress against LF, massive scaling-up of MDA—pursuing LF eradication as soon as possible—was most likely to be cost-effective above a willingness to pay threshold of US$71.5/DALY averted. Intensified MDA scale-up was also associated with lower ICERs. Furthermore, this could result in health systems savings up to US$483 million. Extending coverage to all endemic areas could generate additional economic benefits through gains in worker productivity between US$3.4 and US$14.4 billion.</p>
</sec>
<sec><title>Conclusions</title>
<p>In addition to ethical and political motivations for scaling-up MDA rapidly, this analysis provides economic support for increasing the intensity of MDA programmes.</p>
</sec>
</abstract>
</article-meta>
</front>
</pmc>
</record>
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