Control programs for strongyloidiasis in areas of high endemicity: an economic analysis of different approaches

Infectious Diseases of Poverty

Antonio Montresor¹  Lorenzo Zammarchi²  Sara Boccalini³  Dora Buonfrate⁴  Zeno Bisoffi⁵ 

[1] Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland;Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy;Referral Center for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy;Department of Health Sciences, University of Florence, Florence, Italy;Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy;Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy;Department of Diagnostics and Public Health, University of Verona, Verona, Italy;

关键词: Strongyloides stercoralis;    Strongyloidiasis;    Control programme;    Preventive chemotherapy;    Ivermectin;    Economic;    Adverted death;    Adverted infection;   

DOI  :  10.1186/s40249-021-00858-9

来源: Springer

【 摘 要 】

BackgroundImplementation of control programmes for Strongyloides stercoralis infection is among the targets of the World Health Organization Roadmap to 2030. Aim of this work was to evaluate the possible impact in terms of economic resources and health status of two different strategies of preventive chemotherapy (PC) compared to the current situation (strategy A, no PC): administration of ivermectin to school-age children (SAC) and adults (strategy B) versus ivermectin to SAC only (strategy C).MethodsThe study was conducted at the IRCCS Sacro Cuore Don Calabria hospital, Negrar di Valpolicella, Verona, Italy, at the University of Florence, Italy, and at the WHO, Geneva, Switzerland, from May 2020 to April 2021. Data for the model were extracted from literature. A mathematical model was developed in Microsoft Excel to assess the impact of strategies B and C in a standard population of 1 million subjects living in a strongyloidiasis endemic area. In a case base scenario, 15% prevalence of strongyloidiasis was considered; the 3 strategies were then evaluated at different thresholds of prevalence, ranging from 5 to 20%. The results were reported as number of infected subjects, deaths, costs, and Incremental-Effectiveness Ratio (ICER). A 1-year and a 10-year horizons were considered.ResultsIn the case base scenario, cases of infections would reduce dramatically in the first year of implementation of PC with both strategy B and C: from 172 500 cases to 77 040 following strategy B and 146 700 following strategy C. The additional cost per recovered person was United States Dollar (USD) 2.83 and USD 1.13 in strategy B and C, respectively, compared to no treatment in the first year. For both strategies, there was a downtrend in costs per recovered person with increasing prevalence. The number of adverted deaths was larger for strategy B than C, but cost to advert one death was lower for strategy C than B.ConclusionsThis analysis permits to estimate the impact of two PC strategies for the control of strongyloidiasis in terms of costs and adverted infections/deaths. This could represent a basis on which each endemic country can evaluate which strategy can be implemented, based on available funds and national health priorities.

【 授权许可】

CC BY