African Programme for Onchocerciasis Control 1995–2015: Model-Estimated Health Impact and Cost

Abstract

BackgroundOnchocerciasis causes a considerable disease burden in Africa, mainly through skin and eye disease. Since 1995, the African Programme for Onchocerciasis Control (APOC) has coordinated annual mass treatment with ivermectin in 16 countries. In this study, we estimate the health impact of APOC and the associated costs from a program perspective up to 2010 and provide expected trends up to 2015.Methods and FindingsWith data on pre-control prevalence of infection and population coverage of mass treatment, we simulated trends in infection, blindness, visual impairment, and severe itch using the micro-simulation model ONCHOSIM, and estimated disability-adjusted life years (DALYs) lost due to onchocerciasis. We assessed financial costs for APOC, beneficiary governments, and non-governmental development organizations, excluding cost of donated drugs. We estimated that between 1995 and 2010, mass treatment with ivermectin averted 8.2 million DALYs due to onchocerciasis in APOC areas, at a nominal cost of about US$257 million. We expect that APOC will avert another 9.2 million DALYs between 2011 and 2015, at a nominal cost of US$221 million.ConclusionsOur simulations suggest that APOC has had a remarkable impact on population health in Africa between 1995 and 2010. This health impact is predicted to double during the subsequent five years of the program, through to 2015. APOC is a highly cost-effective public health program. Given the anticipated elimination of onchocerciasis from some APOC areas, we expect even more health gains and a more favorable cost-effectiveness of mass treatment with ivermectin in the near future.

Nodding Syndrome, Western Uganda, 1994

“…Should it turn out that NS indeed is causally connected to infection with O. volvulus, the most effective measure to reduce its burden would probably be to intensify the approved and effective control measures against onchocerciasis in the affected communities. 46 …”

Ivermectin: panacea for resource-poor communities?

“…APOC is recognised as a cost-effective, large-scale public health intervention of enormous significance, preventing an estimated 17.4 million years' worth of healthy life from being lost since the inception of the programme [31]. Impressive results are projected for the intended closure of the programme in 2015 (Box 1).…”

The Barrie Jones Lecture—Eye care for the neglected population: challenges and solutions

“…Success stories abound in the control of vitamin A deficiency 22,23 , onchocerciasis [24][25][26] and trachoma 27,28 . Better understanding of the underlying mechanisms of the disease, epidemiology, pharmacology and surgical techniques have contributed to this phenomenon.…”

“…Better understanding of the underlying mechanisms of the disease, epidemiology, pharmacology and surgical techniques have contributed to this phenomenon. Global partnerships, multisectoral collaboration, public-private partnerships, corporate philanthropy, support from non-governmental organizations -both local and international -and governments are responsible for the success of these programmes 22,23,[25][26][27][28][29] . The philanthropic support through unlimited donation of ivermectin by Merck and azithromycin by Pfizer are outstanding examples of public-private partnership that was pivotal for effective control of onchocerciasis and trachoma.…”