Trends in Parasitology
Projected benefits from integrating NTD programs in sub-Saharan Africa
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.
References (43)
Assessments of pharmacokinetic drug interactions and tolerability of albendazole, praziquantel, and ivermectin combinations
Trans. R. Soc. Trop. Med. Hyg.
(2006)Achieving the Millennium Development Goals
Lancet
(2005)Soil-transmitted helminth infections: updating the global picture
Trends Parasitol.
(2003)The global status of schistosomiasis and its control
Acta Trop.
(2000)Association between microfilarial load and excess mortality in onchocerciasis: an epidemiological study
Lancet
(2004)Lymphatic filariasis: Treatment, control, and elimination
Adv. Parasitol.
(2006)- et al.
Control of onchocerciasis
Adv. Parasitol.
(2006) Implementation of human schistosomiasis control: challenges and prospects
Adv. Parasitol.
(2006)Interventions for the control of soil-transmitted helminthiasis in the community
Adv. Parasitol.
(2006)The possibility of eliminating blinding trachoma
Lancet Infect. Dis.
(2003)
Quantification of clinical morbidity associated with schistosome infection in sub-Saharan Africa
Acta Trop.
An analysis of the safety of the single dose, two drug regimens used in programmes to eliminate lymphatic filariasis
Parasitology
Double-blind placebo-controlled study of concurrent administration of albendazole and praziquantel in schoolchildren with schistosomiasis and geohelminths
J. Infect. Dis.
Global programme to eliminate lymphatic filariasis: progress report for 2004
Wkly Epidemiol. Rec.
Eliminating onchocerciasis as a public health problem
Trop. Med. Int. Health
The global elimination of blinding trachoma: progress and promise
Am. J. Trop. Med. Hyg.
Public health strategies for schistosomiasis control
Community-wide reduction in prevalence and intensity of intestinal helminths as a collateral benefit of lymphatic filariasis elimination programs
Am. J. Trop. Med. Hyg.
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