Background Onchocerciasis (river blindness) is endemic mostly in remote and rural areas in sub-Saharan Africa. The treatment goal for onchocerciasis has shifted from control to elimination in Africa. For investment decisions, national and global policymakers need evidence on benefits, costs and risks of elimination initiatives.

Methods We estimated the health benefits using a dynamical transmission model, and the needs for health workforce and outpatient services for elimination strategies in comparison to a control mode. We then estimated the associated costs to both health systems and households and the potential economic impacts in terms of income gains.

Results The elimination of onchocerciasis in Africa would avert 4.3 million–5.6 million disability-adjusted life years over 2013–2045 when compared with staying in the control mode, and also reduce the required number of community volunteers by 45–53% and community health workers by 56–60%. The elimination of onchocerciasis in Africa when compared with the control mode is predicted to save outpatient service costs by $37.2 million–$39.9 million and out-of-pocket payments by $25.5 million–$26.9 million over 2013–2045, and generate economic benefits up to $5.9 billion–$6.4 billion in terms of income gains.

Discussion The elimination of onchocerciasis in Africa would lead to substantial health and economic benefits, reducing the needs for health workforce and outpatient services. To realise these benefits, the support and collaboration of community, national and global policymakers would be needed to sustain the elimination strategies.