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Is the elimination of ‘sleeping sickness’ affordable? Who will pay the price? Assessing the financial burden for the elimination of human African trypanosomiasis Trypanosoma brucei gambiense in sub-Saharan Africa
  1. C Simone Sutherland1,2,
  2. Fabrizio Tediosi2,3
  1. 1Institute of Pharmaceutical Medicine, Universitat Basel Medizinische Fakultat, Basel, Switzerland
  2. 2Department of Epidemiology and Public Health (EPH), Swiss Tropical and Public Health Institute, Basel, Switzerland
  3. 3Department of Public Health, University of Basel, Basel, Switzerland
  1. Correspondence to Dr C Simone Sutherland; simone.sutherland{at}


Introduction Programme to eliminate neglected tropical diseases (NTDs) have gained global recognition, and may allow for improvements to universal health coverage and poverty alleviation. It is hoped that elimination of human African trypanosomiasis (HAT) Trypanosoma brucei gambiense (Tbg) would assist in this goal, but the financial costs are still unknown. The objective of this analysis was to forecast the financial burden of direct costs of HAT Tbg to funders and society.

Methods In order to estimate the total costs to health services and individuals: (1) potential elimination programmes were defined; (2) the direct costs of programmes were calculated; (3) the per case out-of-pocket payments (OOPs) by programme and financial risk protection indicators were estimated. The total estimated costs for control and elimination programme were reported up till 2020 in international dollars. The mean results for both direct programme costs and OOPs were calculated and reported along with 95% CIs.

Results Across sub-Saharan Africa, HAT Tbg maintaining ‘Control’ would lead to a decline in cases and cost US$630.6 million. In comparison, the cost of ‘Elimination’ programme ranged from US$410.9 million to US$1.2 billion. Maintaining ‘Control’ would continue to cause impoverishment and financial hardship to households; while all ‘Elimination’ programme would lead to significant reductions in poverty.

Conclusion Overall, the total costs of either control or elimination programme would be near US$1 billion in the next decade. However, only elimination programme will reduce the number of cases and improve financial risk protection for households who are impacted by HAT Tbg.

  • economics
  • sleeping sickness
  • neglected tropical diseases (NTDs)
  • elimination
  • finance
  • budget
  • out-of-pocket
  • catastrophic health expenditures
  • financial protection
  • universal health coverage (UHC)
  • sustainable development goals (SDG)
  • Trypanosoma brucei gambiense
  • health policy decision-making

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Handling editor Dr Sanni Yaya

  • Contributors CSS and FT conceived the idea for the study and its design. CSS further developed the study design, completed the analyses and wrote the first draft of the manuscript. Both CSS and FT contributed to further drafts, edits and finalisation of the final manuscript.

  • Funding This project was supported by an Eradication Investment Case (EIC) of onchocheriasis, lymphatic filariasis and human African trypanosomiasis grant #OPP1037660 supported by the Bill and Melinda Gates Foundation (BMGF).

  • Competing interests None declared.

  • Patient and public involvement statement No patients or public participants were involved in this study.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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