Sightsavers, Haywards Heath, United Kingdom.
Sightsavers, Cameroon Country Office, Yaoundé, Cameroon.
PLoS Negl Trop Dis. 2023 Oct 18;17(10):e0011670. doi: 10.1371/journal.pntd.0011670. eCollection 2023 Oct.
Onchocerciasis is a neglected tropical disease with 217.5 million people globally at risk of having the infection. In both settled and semi-nomadic communities of Massangam Health District in Cameroon, Sightsavers has been carrying out test-and-treat with doxycycline and twice-yearly ivermectin distribution. This paper focuses on the cost of test-and-treat with doxycycline in the two community contexts of settled and semi-nomadic.
For the valuation, a combination of gross or micro-costing was used to identify cost components, as well as bottom-up and top-down approaches. The opportunity costs of vehicle and equipment use were estimated and included. Not included, however, were the opportunity costs of building use and Ministry of Public Health staff salaries. We only captured the incremental costs of implementing test-and-treat activities as part of a functional annual community-directed treatment with the ivermectin programme.
We estimate the economic cost per person tested and cost per person treated in Massangam to be US$135 and US$667 respectively. Total implementation cost in the settled community was US$79,409, and in the semi-nomadic community US$69,957. Overall, the total economic cost of implementing the doxycycline test-and-treat strategy for onchocerciasis elimination in Massangam came to US$168,345. Financial costs represented 91% of total costs.
Unit costs of test-and-treat in both settled and semi-nomadic communities are higher than unit costs of community-directed treatment with ivermectin. However, it is critical to note that a two-year implementation shows a significantly larger reduction in infection prevalence than the preceding 20 years of annual community-directed treatment with ivermectin. Test-and-treat with doxycycline may be a cost-effective intervention in places where the prevalence of microfilaria is still high, or in hard-to-reach areas where community-directed treatment with ivermectin and MDA coverage are not high enough to stop transmission or where marginalised populations consistently miss treatment.
盘尾丝虫病是一种被忽视的热带病，全球有 2.175 亿人面临感染风险。在喀麦隆马桑加姆卫生区的定居和半游牧社区，萨塔斯志愿者组织一直在开展强力霉素检测和治疗，并每半年分发一次伊维菌素。本文重点介绍在定居和半游牧两种社区环境下强力霉素检测和治疗的成本。
为了进行评估，使用总费用或微观成本核算来确定成本构成，同时采用自上而下和自下而上的方法。还估算了车辆和设备使用的机会成本，并将其包括在内。但是，建筑使用和公共卫生部工作人员工资的机会成本未包括在内。我们只捕获了作为伊维菌素方案下具有功能的年度社区定向治疗的一部分实施检测和治疗活动的增量成本。
我们估计在马桑加姆，每检测一人的经济成本和每治疗一人的成本分别为 135 美元和 667 美元。在定居社区的总实施成本为 79409 美元，在半游牧社区为 69957 美元。总体而言，在马桑加姆实施强力霉素检测和治疗策略消除盘尾丝虫病的总经济成本为 168345 美元。财务成本占总成本的 91%。
定居和半游牧社区的检测和治疗单位成本高于伊维菌素社区定向治疗的单位成本。然而，必须指出的是，与过去 20 年每年实施伊维菌素社区定向治疗相比，两年的实施显著降低了感染率。在微丝蚴流行率仍然较高的地方，或者在社区定向治疗伊维菌素和 MDA 覆盖率不够高以阻止传播的难以到达的地区，或者边缘化人群持续错过治疗的地方，强力霉素检测和治疗可能是一种具有成本效益的干预措施。
