@article{fdi:010090058,
  title = {{H}ealth economic evaluation of strategies to eliminate gambiense human {A}frican trypanosomiasis in the {M}andoul disease focus of {C}had},
  author = {{A}ntillon, {M}. and {H}uang, {C}. {I}. and {S}utherland, {S}. {A}. and {C}rump, {R}. {E}. and {B}essell, {P}. {R}. and {S}haw, {A}. {P}. {M}. and {T}irados, {I}. and {P}icado, {A}. and {B}ieler, {S}. and {B}rown, {P}. {E}. and {S}olano, {P}hilippe and {M}bainda, {S}. and {D}arnas, {J}. and {W}ang-{S}teverding, {X}. and {C}rowley, {E}. {H}. and {P}eka, {M}. and {T}ediosi, {F}. and {R}ock, {K}. {S}.},
  editor = {},
  language = {{ENG}},
  abstract = {{A}uthor summary{I}n a drive to eliminate human {A}frican trypanosomiasis (g{HAT} or "sleeping sickness") from {C}had following a peak in 2002, the {N}ational {S}leeping {S}ickness {C}ontrol programme and its partners focused on making substantial changes to interventions within the high prevalence setting of {M}andoul. {T}hese included the use of vector control starting in 2014 and improved screening in health facilities starting in 2015. {T}o 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 {M}andoul combined with a cost model. {O}ur analysis indicated that improvements to passive screening enabled more rapid diagnosis and accessible treatment in {M}andoul, 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 g{HAT} set by the {W}orld {H}ealth {O}rganization. {L}ooking 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 {M}andoul. {T}his could therefore enable the shifting of resources to tackle other remaining foci in {C}had. {H}uman {A}frican trypanosomiasis, caused by the gambiense subspecies of {T}rypanosoma brucei (g{HAT}), is a deadly parasitic disease transmitted by tsetse. {P}artners worldwide have stepped up efforts to eliminate the disease, and the {C}hadian government has focused on the previously high-prevalence setting of {M}andoul. {I}n this study, we evaluate the economic efficiency of the intensified strategy that was put in place in 2014 aimed at interrupting the transmission of g{HAT}, and we make recommendations on the best way forward based on both epidemiological projections and cost-effectiveness. {I}n our analysis, we use a dynamic transmission model fit to epidemiological data from {M}andoul 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 g{HAT}), and vector control activities (the deployment of {T}iny {T}argets to control the tsetse vector). {F}or cost-effectiveness analyses, our primary outcome is disease burden, denominated in disability-adjusted life-years ({DALY}s), and costs, denominated in 2020 {US}$. {A}lthough active and passive screening have enabled more rapid diagnosis and accessible treatment in {M}andoul, 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 g{HAT} as set by the {W}orld {H}ealth {O}rganization. {O}ur transmission modelling and economic evaluation suggest that the gains that have been made could be maintained by passive screening. {O}ur 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.},
  keywords = {{TCHAD}},
  booktitle = {},
  journal = {{PL}o{S} {N}eglected {T}ropical {D}iseases},
  volume = {17},
  numero = {7},
  pages = {e0011396 [29 ]},
  ISSN = {1935-2735},
  year = {2023},
  DOI = {10.1371/journal.pntd.0011396},
  URL = {https://www.documentation.ird.fr/hor/fdi:010090058},
}