Cost and cost-effectiveness analysis of mass drug administration compared to school-based targeted preventive chemotherapy for hookworm control in Dak Lak province, Vietnam

Caesar delos Trinos, John Paul; Ng-Nguyen, Dinh; Coffeng, Luc E.; Dyer, Clare E.F.; Clarke, Naomi; Traub, Rebecca; Halton, Kate; Wiseman, Virginia; Watts, Caroline; Nery, Susana Vaz

doi:10.1016/j.lanwpc.2023.100913

Cited by 4 publications

(6 citation statements)

References 27 publications

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“…Cost of distribution of ivermectin was assumed to be as estimated for preventive chemotherapy against soil-transmitted helminths in Dak Lak province, Vietnam. 33 The line for school-based PC at 80% coverage is largely hidden behind the line for school-based PC at 95% coverage. Panels represent settings with different baseline infection prevalence in school age children, as measured with a coprological test (assuming 50% sensitivity and 100% specificity).…”

Section: Resultsmentioning

confidence: 99%

“…For school-based PC implemented at 80% coverage and community-based PC at 65% coverage (which we consider acceptable coverage levels), we assumed that the cost of distribution of ivermectin was as estimated in a recent costing study of school-based PC and community-based PC against soil-transmitted helminths in Dak Lak province, Vietnam (Table 2). 33 These estimates included the 10-year costs of training, community sensitisation, drug distribution (including capital costs, e.g., economic cost of using venues and class rooms), and monitoring and evaluation (deworming day inspections, reporting, parasitological surveys, and data management). We did not correct these estimates for the included cost of albendazole tablets (USD 0.03 per treatment), which contributed less than 5% to the total cost estimate.…”

Section: Cost Of Deliverymentioning

confidence: 99%

“…Expected loss in US dollars as a function of willingness to pay (WTP) per DALY averted in a population of 100,000 individuals.For a given WTP, the most cost-effective strategy is the one that minimises the expected loss (indicated with black open squares). Cost of distribution of ivermectin was assumed to be as estimated for preventive chemotherapy against soil-transmitted helminths in Dak Lak province, Vietnam 33. The line for schoolbased PC at 80% coverage is largely hidden behind the line for school-based PC at 95% coverage.…”

mentioning

confidence: 99%

“…Costs are expressed in thousands of US dollars. Cost of distribution of ivermectin was assumed to be as estimated for preventive chemotherapy against soil-transmitted helminths in Dak Lak province, Vietnam 33. …”

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confidence: 99%

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Cost-effectiveness of mass drug administration with ivermectin against strongyloidiasis: a modelling study

Coffeng,

Lo,

de Vlas

2024

Preprint

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Background: Strongyloidiasis, caused by the parasitic intestinal worm Strongyloides stercoralis, infects hundreds of millions of people globally. Current school-based preventive chemotherapy (PC) programs that use benzimidazole derivatives (e.g., albendazole) against soil-transmitted helminths do not effectively treat strongyloidiasis, which requires treatment with ivermectin. We estimate the cost-effectiveness of mass drug administration with ivermectin for the control of strongyloidiasis. Methods: We developed a mathematical model to simulate the population dynamics of S. stercoralis and the impact of school-based and community-wide PC across a range of epidemiological settings. We simulated 10-year PC programs with varying treatment coverages. We estimated a primary outcome of disability-adjusted life years (DALYs) averted by each PC strategy and calculate the programmatic cost (US$) of each strategy. We estimated cost-effectiveness by comparing strategies by their incremental cost-effectiveness ratios (US$/averted DALY) and expected loss curves. Findings: The model found community-based PC was the most cost-effective strategy (≤600 US$ / DALY averted), despite costing approximately 5 times as much as school-based PC. Community-based PC targeted at ages 5 and above reduced infection levels close to 0% within 5 to 6 years. School-based PC was predicted to have very little impact. These results were robust across a range of epidemiologic settings above a measured prevalence of 2-5% in school age children. Interpretation: Annual community-based PC is the most cost-effective public health strategy to control strongyloidiasis, being superior to school-based PC due to most of the infections and mortality occurring in adults. A baseline prevalence of 2% of infection in school age children, as measured by Baermann or stool culture, is a suitable minimum threshold for cost-effective implementation of community-based PC. Funding: World Health Organization.

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Section: Resultsmentioning

confidence: 99%

Section: Cost Of Deliverymentioning

confidence: 99%

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Cost-effectiveness of mass drug administration with ivermectin against strongyloidiasis: a modelling study

Coffeng,

Lo,

de Vlas

2024

Preprint

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“…In the same issue of The Lancet Regional Health—Western Pacific , Trinos and colleagues 8 present a detailed cost survey of the CoDe-STH trial and use these costs as inputs to compare the general cost-effectiveness of MDA within the community (full population) versus within only schools (enrolled children aged 5–14 years) for STHs in Dak Lak, Vietnam. This model considers the donation of medicines for school-based MDA and the direct purchase of medicines for community-based MDA.…”

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confidence: 99%

Community-based deworming for hookworm benefits children treated within schools and is cost-effective due to economies of scale: the CoDe-STH trial

Chami

2023

The Lancet Regional Health - Western Pacific

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Ancylostoma ceylanicum and other zoonotic canine hookworms: neglected public and animal health risks in the Asia–Pacific region

Tenorio,

Tabios,

Inpankaew

et al. 2024

Animal Diseases

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Zoonotic hookworm infections remain a significant public health problem, causing nearly 500 million cases globally and approximately four million disability-adjusted life years lost annually. More than one-fifth of these cases are attributed to Ancylostoma ceylanicum, an emerging zoonotic health issue in the Asia-Pacific region. This review presents key research gaps regarding the epidemiology, diagnosis, control, prevention and elimination of A. ceylanicum and other canine zoonotic hookworms as neglected health threats. A. ceylanicum is the second most prevalent human hookworm in the region; it is the most common hookworm among dogs and cats-reservoirs of zoonotic infections. Previous population genetic and phylogenetic analyses revealed that A. ceylanicum has three possible transmission dynamics: zoonotic, animal-only, and human-only pathways. The actual burden of zoonotic ancylostomiasis in most endemic countries remains unknown due to the use of parasitological techniques (e.g., Kato-Katz thick smear and floatation techniques) that have reduced diagnostic performance and do not allow accurate species identification in helminth surveys. The emergence of benzimidazole resistance in soil-transmitted helminths (STHs), including hookworms, is a concern due to the protracted implementation of mass drug administration (MDA). Resistance is conferred by single nucleotide polymorphisms (SNPs) that occur in the β-tubulin isotype 1 gene. These mutations have been reported in drug-resistant A. caninum but have not been found in A. ceylanicum in the field. A. ceylanicum remains understudied in the Asia-Pacific region. The zoonotic nature of the parasite warrants investigation of its occurrence in human and animal reservoir hosts to understand the dynamics of zoonotic transmission in different endemic foci. The detection of benzimidazole resistance-associated SNPs in zoonotic hookworms from Asia-Pacific countries has yet to be thoroughly explored. Considering the high level of hookworm endemicity in the region, the circulation of resistant isolates between humans and animals potentially presents a significant One Health threat that can undermine current MDA and proposed animal deworming-based control efforts.

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Cost and cost-effectiveness analysis of mass drug administration compared to school-based targeted preventive chemotherapy for hookworm control in Dak Lak province, Vietnam

Cited by 4 publications

References 27 publications

Cost-effectiveness of mass drug administration with ivermectin against strongyloidiasis: a modelling study

Cost-effectiveness of mass drug administration with ivermectin against strongyloidiasis: a modelling study

Community-based deworming for hookworm benefits children treated within schools and is cost-effective due to economies of scale: the CoDe-STH trial

Ancylostoma ceylanicum and other zoonotic canine hookworms: neglected public and animal health risks in the Asia–Pacific region

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