Projected benefits from integrating NTD programs in sub-Saharan Africa

https://doi.org/10.1016/j.pt.2006.05.007Get rights and content

The integration of preventive chemotherapy programs (PCPs) targeting multiple neglected tropical diseases (NTDs) with similar strategic approaches offers opportunities for enhanced cost-effectiveness. To estimate the potential cost savings and health outcomes of integrated programs, the data available for five NTDs (lymphatic filariasis, onchocerciasis, intestinal helminthiasis, schistosomiasis and trachoma) can be used to define eligible target populations, the probable overlap of at-risk populations, and the cost per person treated in stand-alone and integrated programs. If all targets for 2006 in sub-Saharan Africa are met, then savings of 26–47% can be projected from such integration (a cost of US $58–81 million versus $110 million for stand-alone PCPs). These first estimates can be refined as empirical data become available from integrated PCPs in the future.

Section snippets

Integrating programs targeting NTDs

Much attention in global health has recently focused on the three most widely recognized devastating diseases – namely, malaria, tuberculosis and AIDS – but lesser-known infections or ‘neglected tropical diseases’ (NTDs) relentlessly persist in exacting severe physical, psychosocial and economic toll on the poorest, most marginalized populations of the developing world [1]. For some of these NTDs, however, preventative solutions are now at hand, and active global initiatives have been created

Analyzing cost savings

To estimate the cost savings from program integration, it is necessary to identify the target populations eligible for treatment for each disease-specific program, to estimate the overlap of populations targeted for each disease-specific program, and to determine the cost per person receiving drugs both in stand-alone programs and in the integrated programs.

Analyzing outcomes

Projecting health outcomes of the integrated disease control packages in sub-Saharan Africa relies on the PCP treatment to prevent the major clinical manifestations of each disease, including blindness (onchocerciasis and trachoma), severe skin disease and itching (onchocerciasis), lymphedema and hydrocele (lymphatic filariasis), liver, kidney, and bladder disease (schistosomiasis), anemia (STH and schistosomiasis) and protection from infection with STHs. We estimated the number of cases

Costs

Estimating the target populations eligible for treatment (Table 3), the per-person cost of drug treatment in stand-alone programs (Table 4), the overlap of the NTD programs, and the per-person cost of drug treatment in integrated programs (Table 5) enabled us to calculate the total cost savings that can be made from disease program integration in sub-Saharan Africa. The projected cost of treating each disease separately in 2006 is $110 million (Table 4). By contrast, the estimated total cost

Health outcomes

Box 1 shows the projected outcomes anticipated from integration of the five NTD PCPs that we have ‘costed’ for sub-Saharan Africa in 2006 (Table 5). Many of these outcomes can be realized immediately (i.e. within the first year of the PCP); others, whose more chronic manifestations of disease take years to develop (e.g. hydrocele or blindness) will be realized only after many years. All of the outcomes, however, must be recognized as products of the integrated PCPs.

Refining the projections

We have estimated that the savings achieved through ‘integrating’ the PCPs for five NTDs in sub-Saharan Africa could approximate 26–47% of the cost of carrying out the individual, stand-alone PCPs. Given the current lack of substantive data, however, a great many uncertainties remain about our estimates and their underlying assumptions, of which the following are particularly important.

  • (i) There is uncertainty about the true geographic distributions and prevalence of the infections. These

Concluding remarks

Despite its significant limitations, this exercise to estimate the potential cost savings and impact of integrating the PCPs for five of the most significant NTDs has focused on an issue of great importance that must be addressed. As integrated activities are undertaken and implemented on an ever-larger scale, an increasing amount of data will become available to improve the necessarily imprecise estimates of our current analysis. Indeed, the goal of this exercise has been not only to provide a

Acknowledgements

We thank our colleagues at the Global Programme to Eliminate Lymphatic Filariasis, International Trachoma Initiative, Mectizan® Donation Program, Schistosomiasis Control Initiative, and World Health Organization for their help and willingness to share insight and to collaborate.

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