The potential impact of moxidectin on onchocerciasis elimination in Africa: an economic evaluation based on the Phase II clinical trial data

Particle and Fibre Toxicology

María-Gloria Basáñez⁴  Annette C Kuesel³  Kwablah Awadzi¹  Nicholas O Opoku¹  Simon K Attah²  Martin Walker⁴  Hugo C Turner⁴ 

[1] Onchocerciasis Chemotherapy Research Centre, Hohoe, Ghana;Department of Microbiology, University of Ghana Medical School, Accra, Ghana;UNICEF/UNDP/World Bank/ WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland;Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, St Mary’s Campus, Norfolk Place, London W2 1PG, UK

关键词: Seasonality;    Economic evaluation;    Ivermectin;    Moxidectin;    Onchocerciasis;   

Others  :  1146453
DOI  :  10.1186/s13071-015-0779-4

 received in 2015-01-10, accepted in 2015-03-04,  发布年份 2015

【 摘 要 】

Background

Spurred by success in several foci, onchocerciasis control policy in Africa has shifted from morbidity control to elimination of infection. Clinical trials have demonstrated that moxidectin is substantially more efficacious than ivermectin in effecting sustained reductions in skin microfilarial load and, therefore, may accelerate progress towards elimination. We compare the potential cost-effectiveness of annual moxidectin with annual and biannual ivermectin treatment.

Methods

Data from the first clinical study of moxidectin were used to parameterise the onchocerciasis transmission model EPIONCHO to investigate, for different epidemiological and programmatic scenarios in African savannah settings, the number of years and in-country costs necessary to reach the operational thresholds for cessation of treatment, comparing annual and biannual ivermectin with annual moxidectin treatment.

Results

Annual moxidectin and biannual ivermectin treatment would achieve similar reductions in programme duration relative to annual ivermectin treatment. Unlike biannual ivermectin treatment, annual moxidectin treatment would not incur a considerable increase in programmatic costs and, therefore, would generate sizeable in-country cost savings (assuming the drug is donated). Furthermore, the impact of moxidectin, unlike ivermectin, was not substantively influenced by the timing of treatment relative to seasonal patterns of transmission.

Conclusions

Moxidectin is a promising new drug for the control and elimination of onchocerciasis. It has high programmatic value particularly when resource limitation prevents a biannual treatment strategy, or optimal timing of treatment relative to peak transmission season is not feasible.

【 授权许可】

   
2015 Turner et al.; licensee BioMed Central.

【 图 表 】

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【 参考文献 】

• [1]World Health Organization. 18th Session of the Joint Action Forum. Bujumbura, Burundi; 2012. http://www.who.int/apoc/media/Journal_du_FAC_day_4_Anglais.pdf
• [2]London Declaration on Neglected Tropical Diseases. Ending the neglect and reaching 2020 goals. London, UK; 2012. http://unitingtocombatntds.org/downloads/press/ntd_event_london_declaration_on_ntds.pdf
• [3]Meredith SEO, Dull HB. Onchocerciasis: The first decade of MectizanTM treatment. Parasitol Today. 1998; 14(12):472-4.
• [4]Eberhard M. Progress toward elimination of onchocerciasis in the Americas - 1993–2012. MMWR Morb Mortal Wkly Rep. 2013; 62(20):405-8.
• [5]Progress towards eliminating onchocerciasis in the WHO Region of the Americas: verification by WHO of elimination of transmission in Colombia. Wkly Epidemiol Rec. 2013; 88(36):381-5.
• [6]World Health Organization. Onchocerciasis - river blindness. http://www.who.int/mediacentre/factsheets/fs095/en/
• [7]Diawara L, Traoré MO, Badji A, Bissan Y, Doumbia K, Goita SF et al.. Feasibility of onchocerciasis elimination with ivermectin treatment in endemic foci in Africa: first evidence from studies in Mali and Senegal. PLoS Negl Trop Dis. 2009; 3(7):e497.
• [8]Traoré MO, Sarr MD, Badji A, Bissan Y, Diawara L, Doumbia K et al.. Proof-of-principle of onchocerciasis elimination with ivermectin treatment in endemic foci in Africa: final results of a study in Mali and Senegal. PLoS Negl Trop Dis. 2012; 6(9):e1825.
• [9]Ndyomugyenyi R, Lakwo T, Habomugisha P, Male B. Progress towards the elimination of onchocerciasis as a public-health problem in Uganda: opportunities, challenges and the way forward. Ann Trop Med Parasitol. 2007; 101(4):323-33.
• [10]Osei-Atweneboana MY, Eng JKL, Boakye DA, Gyapong JO, Prichard RK. Prevalence and intensity of Onchocerca volvulus infection and efficacy of ivermectin in endemic communities in Ghana: a two-phase epidemiological study. Lancet. 2007; 369(9578):2021-9.
• [11]Onchocerciasis Control in Special Intervention Zones Including Sierra Leone in the OCP Area. Joint Programme Committee Report. World Health Organization/African Programme for Onchocerciasis Control, Ouagadougou (Burkina Faso); 2002.
• [12]Turner HC, Walker M, Churcher TS, Osei-Atweneboana MY, Biritwum N-K, Hopkins A et al.. Reaching the London declaration on neglected tropical diseases goals for onchocerciasis: an economic evaluation of increasing the frequency of ivermectin treatment in Africa. Clin Infect Dis. 2014; 59(7):923-32.
• [13]African Programme for Onchocerciasis Control. Conceptual and Operational Framework of Onchocerciasis Elimination with Ivermectin Treatment. WHO/APOC; 2010. http://www.who.int/apoc/oncho_elimination_report_english.pdf
• [14]Coffeng LE, Stolk WA, Hoerauf A, Habbema D, Bakker R, Hopkins AD et al.. Elimination of African onchocerciasis: modeling the impact of increasing the frequency of ivermectin mass treatment. Plos One. 2014; 9(12):e115886.
• [15]Turner HC, Osei-Atweneboana MY, Walker M, Tettevi EJ, Churcher TS, Asiedu O et al.. The cost of annual versus biannual community-directed treatment with ivermectin: Ghana as a case study. PLoS Negl Trop Dis. 2013; 7(9):e2452.
• [16]Prichard R, Ménez C, Lespine A. Moxidectin and the avermectins: Consanguinity but not identity. Int J Parasitol Drugs Drug Resist. 2012; 2:134-53.
• [17]Awadzi K, Opoku NO, Attah SK, Lazdins-Helds J, Kuesel AC. A randomized, single-ascending-dose, ivermectin-controlled, double-blind study of moxidectin in Onchocerca volvulus infection. PLoS Negl Trop Dis. 2014; 8(6):e2953.
• [18]Filipe JAN, Boussinesq M, Renz A, Collins RC, Vivas-Martinez S, Grillet ME et al.. Human infection patterns and heterogeneous exposure in river blindness. Proc Natl Acad Sci U S A. 2005; 102(42):15265-70.
• [19]Turner HC, Churcher TS, Walker M, Osei-Atweneboana MY, Prichard RK, Basáñez MG. Uncertainty surrounding projections of the long-term impact of ivermectin treatment for human onchocerciasis. PLoS Negl Trop Dis. 2013; 7(4):e2169.
• [20]Basáñez MG, Pion SDS, Boakes E, Filipe JAN, Churcher TS, Boussinesq M. Effect of single-dose ivermectin on Onchocerca volvulus: a systematic review and meta-analysis. Lancet Infect Dis. 2008; 8(5):310-22.
• [21]Turner HC, Walker M, Churcher TS, Basáñez MG. Modelling the impact of ivermectin on River Blindness and its burden of morbidity and mortality in African Savannah: EpiOncho projections. Parasit Vectors. 2014; 7:241. BioMed Central Full Text
• [22]Anderson RM, May RM. Infectious Diseases of Humans: Dynamics and Control. Oxford Science Publications, Oxford; 1991.
• [23]World Health Organization. Making choices in health: WHO guide to cost-effectiveness analysis. Geneva: World Health Organization. WHO; 2003. http://www.who.int/choice/publications/p_2003_generalised_cea.pdf
• [24]Taylor MJ, Hoerauf A, Bockarie M. Lymphatic filariasis and onchocerciasis. Lancet. 2010; 376(9747):1175-85.
• [25]Mackenzie CD, Geary TG. Flubendazole: a candidate macrofilaricide for lymphatic filariasis and onchocerciasis field programs. Expert Rev Anti Infect Ther. 2011; 9(5):497-501.
• [26]Mackenzie CD, Geary TG. Addressing the current challenges to finding new anthelminthic drugs. Expert Rev Anti Infect Ther. 2013; 11(6):539-41.
• [27]Walker M, Specht S, Churcher TS, Hoerauf A, Taylor MJ, Basáñez MG: Therapeutic efficacy and macrofilaricidal activity of Doxycycline for the treatment of River Blindness. Clin Infect Dis 2014 Dec 23; pii: ciu1152 [Epub ahead of print].
• [28]Mackenzie CD, Homeida MM, Hopkins AD, Lawrence JC. Elimination of onchocerciasis from Africa: possible? Trends Parasitol. 2012; 28(1):16-22.
• [29]Hotez PJ, Bottazzi ME, Zhan B, Makepeace BL, Klei TR, Abraham D, et al. The Onchocerciasis Vaccine for Africa—TOVA—Initiative. PLoS Negl Trop Dis. 2015;9(1):e0003422.
• [30]African Programme for Onchocerciasis Control. Report of the 36th session of the Technical Consultative Committee, Ouagadougou, Burkina Faso; 2013. http://www.who.int/apoc/about/structure/tcc/TCC36_Final_Report_170513.pdf
• [31]Turner HC, Walker M, French MD, Blake IM, Churcher TS, Basáñez MG. Neglected tools for neglected diseases: mathematical models in economic evaluations. Trends Parasitol. 2014; 30(12):562-70.
• [32]Basáñez MG, Churcher TS, Grillet ME. Onchocerca-Simulium interactions and the population and evolutionary biology of Onchocerca volvulus. Adv Parasitol. 2009; 68:263-313.
• [33]Basáñez MG, French MD, Walker M, Churcher TS. Paradigm lost: how parasite control may alter pattern and process in human helminthiases. Trends Parasitol. 2012; 28(4):161-71.
• [34]Gardon J, Gardon-Wendel N, Demanga N, Kamgno J, Chippaux JP, Boussinesq M. Serious reactions after mass treatment of onchocerciasis with ivermectin in an area endemic for Loa loa infection. Lancet. 1997; 350(9070):18-22.
• [35]World Health Organization. Criteria for certification of interruption of transmission/elimination of human onchocerciasis. Report of a meeting held in Geneva, 28–29 September 2000. Geneva: WHO; 2001. WHO/CDS/CPE/CEE/2001.18a. http://www.oepa.net/Documentos/CriteriosCertificacionOMS/WHO_CDS_CPE_CEE_2001.18a.pdf
• [36]Duerr HP, Raddatz G, Eichner M. Control of onchocerciasis in Africa: threshold shifts, breakpoints and rules for elimination. Int J Parasitol. 2011; 41(5):581-9.
• [37]Engelman D, Kiang K, Chosidow O, McCarthy J, Fuller C, Lammie P et al.. Toward the global control of human scabies: introducing the International Alliance for the Control of Scabies. PLoS Negl Trop Dis. 2013; 7(8):e2167.
• [38]African Programme for Onchocerciasis Control. APOC statement on the 2015 annual letter of the Bill & Melinda Gates Foundation. http://www.who.int/apoc/APOC_Statement_on_annual_letter_of_BMGF.pdf?ua=1
• [39]African Programme for Onchocerciasis Control. Programme for the Elimination of Neglected Diseases in Africa (PENDA). WHO/APOC; 2013. http://www.who.int/apoc/en_apoc_strategic_plan_2013_ok.pdf
• [40]Opara KN, Fagbemi OB, Ekwe A, Okenu DM. Status of forest onchocerciasis in the lower cross river basin, Nigeria: entomologic profile after five years of ivermectin intervention. Am J Trop Med Hyg. 2005; 73(2):371-6.