Health economic evaluation of strategies to eliminate gambiense human African trypanosomiasis in the Mandoul disease focus of Chad

2023

Article référencé dans le Web of Science WOS:001041243000002

Antillon M., Huang C. I., Sutherland S. A., Crump R. E., Bessell P. R., Shaw A. P. M., Tirados I., Picado A., Bieler S., Brown P. E., Solano Philippe, Mbainda S., Darnas J., Wang-Steverding X., Crowley E. H., Peka M., Tediosi F., Rock K. S.

PLoS Neglected Tropical Diseases, 2023, 17 (7), p. e0011396 [29 p.] ISSN 1935-2735

Author summaryIn a drive to eliminate human African trypanosomiasis (gHAT or "sleeping sickness") from Chad following a peak in 2002, the National Sleeping Sickness Control programme and its partners focused on making substantial changes to interventions within the high prevalence setting of Mandoul. These included the use of vector control starting in 2014 and improved screening in health facilities starting in 2015. To explore whether these interventions were an efficient use of resources we carried out a retrospective analysis using a dynamic transmission model fit to epidemiological data from Mandoul combined with a cost model. Our analysis indicated that improvements to passive screening enabled more rapid diagnosis and accessible treatment in Mandoul, and furthermore the addition of vector control provided a good value-for-money and substantially increased the probability of reaching the 2030 elimination of transmission target for gHAT set by the World Health Organization. Looking forwards, our prospective analysis also considers the health economics of future strategies and concludes that the scaleback of vertical interventions appears cost-effective if passive screening remains operational in Mandoul. This could therefore enable the shifting of resources to tackle other remaining foci in Chad. Human African trypanosomiasis, caused by the gambiense subspecies of Trypanosoma brucei (gHAT), is a deadly parasitic disease transmitted by tsetse. Partners worldwide have stepped up efforts to eliminate the disease, and the Chadian government has focused on the previously high-prevalence setting of Mandoul. In this study, we evaluate the economic efficiency of the intensified strategy that was put in place in 2014 aimed at interrupting the transmission of gHAT, and we make recommendations on the best way forward based on both epidemiological projections and cost-effectiveness. In our analysis, we use a dynamic transmission model fit to epidemiological data from Mandoul to evaluate the cost-effectiveness of combinations of active screening, improved passive screening (defined as an expansion of the number of health posts capable of screening for gHAT), and vector control activities (the deployment of Tiny Targets to control the tsetse vector). For cost-effectiveness analyses, our primary outcome is disease burden, denominated in disability-adjusted life-years (DALYs), and costs, denominated in 2020 US. Although active and passive screening have enabled more rapid diagnosis and accessible treatment in Mandoul, the addition of vector control provided good value-for-money (at less than 750/DALY averted) which substantially increased the probability of reaching the 2030 elimination target for gHAT as set by the World Health Organization. Our transmission modelling and economic evaluation suggest that the gains that have been made could be maintained by passive screening. Our analysis speaks to comparative efficiency, and it does not take into account all possible considerations; for instance, any cessation of ongoing active screening should first consider that substantial surveillance activities will be critical to verify the elimination of transmission and to protect against the possible importation of infection from neighbouring endemic foci.

Santé : généralités [050] ; Entomologie médicale / Parasitologie / Virologie [052]

TCHAD

Fonds IRD [F B010090058]

fdi:010090058