African trypanosomiasis, or sleeping sickness, is a tropical disease caused by trypanosome parasites transmitted by tsetse flies. The focus of this paper is on the cost-effectiveness of alternative drug treatments for patients in the late stage of the disease. Melarsoprol has been used for many decades. More recently, eflornithine has been developed. It has fewer side effects and improves the overall cure rate. It is much more expensive than melarsoprol, however. The objective of the present cost-effectiveness is to identify the costs and benefits that would be involved in switching from melarsoprol to eflornithine in the treatment of late stage sleeping sickness. Benefits are expressed in lives saved as well as in disability adjusted life years (DALYs). The analysis is applied to the case of Uganda. The implications for affordability are also considered, by taking account of how the treatment costs would be shared between the national government, donors and patients. The baseline results indicate that melarsoprol treatment is associated with an incremental cost per life and DALY saved of $209 and $8, respectively. Each additional life saved by switching from melarsoprol alone to a combination of melarsoprol and eflornithine would cost an extra $1,033 per life saved, and an extra $40.9 per DALY gained. Shifting from this second alternative to treatment of all patients with eflornithine leads to an incremental cost per life saved of $4,444 and an incremental cost of $166.8 per DALY gained.

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Infection with soil-transmitted helminths (STHs) is a major public health problem in many developing countries; pregnant women and children are particularly at risk. Preventive chemotherapy (PC) -the intervention currently recommended by the World Health Organization (WHO) against the main helminth infections, including those caused by STHs -aims at reducing morbidity through periodical administration of anthelminthic drugs either alone or in combination.The Expanded Programme on Immunization (EPI) is one of the most widely implemented health programmes in the world and has a well-established access to children and women. The present study investigated the cost of the provision of anthelminthic drugs during existing immunization campaigns.In Lao PDR the use of this integrated approach compared to implementation of the vertical deworming campaign alone allowed reduction of the individual cost of deworming by 10 times (from US$0.25 in the vertical deworming campaign to US$0.02 in the integrated campaign). Burden posed on health workers by the integration process was perceived as minimal and manageable. Besides, delivery of anthelminthic drugs during the immunization campaigns enabled Authors' contributions: All the authors conceived and designed the study; GB conducted the questionnaire survey; GB, PEA, KF, AZ, KP, KS, CC and SP collected the budget data; GB and AY carried out data analysis; GB, AY, AFG, CP and AM interpreted the results of the analysis; GB and AY prepared the draft manuscript, all the authors critically reviewed and gave final approval of the version to be published. AM is the guarantor of the paper. Conflicts of interest: None declared.Ethical approval: As the study was carried out as a part of the vaccination campaign, ethical approval was not required. Informed consent was obtained by all the interviewees prior to the questionnaire survey. Europe PMC Funders Group Europe PMC Funders Author ManuscriptsEurope PMC Funders Author Manuscripts campaign teams to directly observe drug intake, which assured safety. Our findings prove that integration is an opportunity to maximize health benefits through the delivery of multiple health products and the attainment of a high coverage.

Financing is becoming increasingly important as the cost of immunizing the world's children continues to rise. By 2015, that cost will likely exceed US$60 per infant as new vaccines are introduced into national immunization programs. In 2006, 51 lower and lower middle income countries reported spending a mean US$12 per surviving infant on routine immunization. By 2012, the figure had risen to $20, a 67% increase. This study tests the hypothesis that lower and lower middle income countries will spend more on their routine immunization programs as their economies grow. A panel data regression approach is used. Expenditures reported by governments annually (2006-12) through the World Health Organization/UNICEF Joint Reporting Form are regressed on lagged annual per capita gross national income (GNI), controlling for prevailing mortality levels, immunization program performance, corruption control efforts, geographical region and correct reporting. Results show the expenditures increased with GNI. Expressed as an elasticity, the countries spent approximately $6.32 on immunization for every $100 in GNI increase from 2006 to 2012. Projecting forward and assuming continued annual GNI growth rates of 10.65%, countries could be spending $60 per infant by 2020 if national investment functions increase 4-fold. Given the political will, this result implies countries could fully finance their routine immunization programs without cutting funding for other programs.