Health economic evaluation of strategies to eliminate gambiense human African trypanosomiasis in the Mandoul disease focus of Chad

作者：Marina Antillón, Ching-I Huang, Samuel A. Sutherland, Ronald E. Crump, Paul R. Bessell, Alexandra Shaw, Iñaki Tirados, Albert Picado, Sylvain Biéler, Paul E. Brown, Philippe Solano, Severin Mbainda, Justin Darnas, Xia Wang, Emily Crowley, Mallaye Péka, Fabrizio Tediosi, Kat S. Rock · 发表于：PLoS neglected tropical diseases · 年份：2023 · DOI：10.1371/journal.pntd.0011396 · 被引用次数：4 · 研究领域：Trypanosoma species research and implications、Parasitic Diseases Research and Treatment、Parasites and Host Interactions

Human African trypanosomiasis, caused by the gambiense subspecies of Trypanosoma brucei (gHAT), is a deadly parasitic disease transmitted by tsetse. Partners worldwide have stepped up efforts to eliminate the disease, and the Chadian government has focused on the previously high-prevalence setting of Mandoul. In this study, we evaluate the economic efficiency of the intensified strategy that was put in place in 2014 aimed at interrupting the transmission of gHAT, and we make recommendations on the best way forward based on both epidemiological projections and cost-effectiveness. In our analysis, we use a dynamic transmission model fit to epidemiological data from Mandoul to evaluate the cost-effectiveness of combinations of active screening, improved passive screening (defined as an expansion of the number of health posts capable of screening for gHAT), and vector control activities (the deployment of Tiny Targets to control the tsetse vector). For cost-effectiveness analyses, our primary outcome is disease burden, denominated in disability-adjusted life-years (DALYs), and costs, denominated in 2020 US$. Although active and passive screening have enabled more rapid diagnosis and accessible treatment in Mandoul, the addition of vector control provided good value-for-money (at less than $750/DALY averted) which substantially increased the probability of reaching the 2030 elimination target for gHAT as set by the World Health Organization. Our transmission modelling and economic...