The Cost of Antibiotic Mass Drug Administration for Trachoma Control in a Remote Area of South Sudan

Abstract

BackgroundMass drug administration (MDA) of antibiotics is a key component of the so-called “SAFE” strategy for trachoma control, while MDA of anthelminthics provides the cornerstone for control of a number of other neglected tropical diseases (NTDs). Simultaneous delivery of two or more of these drugs, renowned as “integrated NTD control,” is being promoted to reduce costs and expand intervention coverage. A cost analysis was conducted alongside an MDA campaign in a remote trachoma endemic area, to inform budgeting for NTD control in South Sudan.Methods and FindingsA first round of antibiotic MDA was conducted in the highly trachoma endemic county of Mayom, Unity state, from June to August 2010. A core team of seven staff delivered the intervention, including recruitment and training of 44 supervisors and 542 community drug distributors. Using an ingredients approach, financial and economic costs were captured from the provider perspective in a detailed costing database. Overall, 123,760 individuals were treated for trachoma, resulting in an estimated treatment coverage of 94%. The economic cost per person treated was USD 1.53, excluding the cost of the antibiotic azithromycin. Ninety four per cent of the delivery costs were recurrent costs, with personnel and travel/transport costs taking up the largest share.ConclusionsIn a remote setting and for the initial round, MDA of antibiotics was considerably more expensive than USD 0.5 per person treated, an estimate frequently quoted to advocate for integrated NTD control. Drug delivery costs in South Sudan are unlikely to decrease substantially during subsequent MDA rounds, as the major cost drivers were recurrent costs. MDA campaigns for delivery of one or more drugs in South Sudan should thus be budgeted at around USD 1.5 per person treated, at least until further costing data for delivery of other NTD drugs, singly or in combination, are available.

Costs of Testing for Ocular Chlamydia trachomatis Infection Compared to Mass Drug Administration for Trachoma in The Gambia: Application of Results from the PRET Study

“…Enhancing coverage via an extra treatment visit to each community cost a further $0.04 per head, improved coverage in 0–9 year-olds by about 3%, but had no effect on outcome and, in this setting, was not worthwhile. The treatment costs are less than the $ 1.53 per head reported in South Sudan [ 18 ], but similar to the $ 0.25 estimate from Mali [ 19 ]. A cost of ≤$0.50 per person for trachoma treatment has been quoted in the literature when assessing programme sustainability or cost savings through integrated treatment campaigns targeting several neglected tropical diseases [ 18 , 20 , 21 ].…”

“…The main drivers were personnel costs followed by supervision. Others have also found personnel to be the major cost from all cost categories in population-based prevalence surveys [ 22 ] and trachoma mass antibiotic treatment distributions [ 18 ]. Interestingly, both these studies found transportation to be the next most expensive cost category after personnel, whereas it was not a major cost in our study.…”

A mixed methods approach to evaluating community drug distributor performance in the control of neglected tropical diseases

“…Few, however, look at time spent by CDDs in distributing health packages [ 31 ]. Furthermore, the costs of CDD involvement in programmes is rarely valued nor included in programme economic evaluations [ 32 , 33 ]. In this study, time allocated by the CDDs towards their NTD Programme duties were a significant factor affecting their performance.…”

Trachoma

“…Integrating trachoma programs with other neglected tropical diseases may prove cost-effective, since close to 95% of drug distribution costs have been attributed to recurring costs (personnel, travel, etc. )[78]. However, overlap between diseases would need to be considered to ensure effective integration.…”