Modelling the Cost of Engage & Treat and Test & Treat Strategies Towards the Elimination of Lymphatic Filariasis in Ghana

Overview

Journal PLoS Negl Trop Dis

Specialties Infectious Diseases
Tropical Medicine

Date 2024 May 24

PMID 38787898

Authors

Nathaniel N K Adams

Collins S Ahorlu

Dziedzom K de Souza

Moses Aikins

Affiliations

Soon will be listed here.

Abstract

Background: Despite several years of LF-MDA implementation, Ghana still has some districts with mf prevalence >1%, partly due to poor treatment coverage levels resulting from non-participation in MDA. To address the challenges, we implemented Engage & Treat (E&T) and Test & Treat (T&T) strategies for individuals who miss or refuse MDA respectively, in a hotspot district, enabling us to reach many of those who seldom, or never, take part in MDA. This financial cost study was undertaken to analyse data on the LF-MDA, E&T and T&T implementation in 2021 and the financial cost to inform the rollout of the E&T and T&T as mop-up strategies in future LF-MDAs.

Methods: This costing study analysed cost data from the 2021 LF-MDA implementation activities carried out by the Neglected Tropical Diseases (NTD) programme of the Ghana Health Service and the SENTINEL study, carried out in Ahanta West district for the two interventions (i.e., E&T and T&T). The 2021 Ghana Population and Housing Census data was used to estimate the LF-MDA-eligible population. The financial cost per person treated was estimated and these costs were applied to the projected population to obtain the financial cost for subsequent years.

Results: Implementing MDA mop-up strategies either through the E&T or T&T to improve coverage comes at an additional cost to the elimination goals. For example, in 2024 the projected cost per person treated by the routine LF-MDA is estimated at US$0.83. The cost using the integrated LF-MDA and the E&T, T&T led by the NTD programme or T&T integrated into the health system was estimated at US$1.62, US$2.88, and US$2.33, respectively, for the same year. Despite the increased cost, the proposed combined LF-MDA and mop-up strategies will have a higher estimated population treated for 2024 (i.e., 1,392,211) compared to the routine LF-MDA approach (i.e., 988,470) for the same year.

Conclusion: Combining LF-MDA with E&T/T&T mop-up strategies, despite their high costs, may provide NTD Programmes with the options of improving treatment coverage and reaching the LF elimination target sooner, given that the routine LF-MDA alone approach has been implemented for many years with some districts yet to reach the elimination targets.

References

Biritwum N, Yikpotey P, Marfo B, Odoom S, Mensah E, Asiedu O . Persistent 'hotspots' of lymphatic filariasis microfilaraemia despite 14 years of mass drug administration in Ghana. Trans R Soc Trop Med Hyg. 2017; 110(12):690-695. DOI: 10.1093/trstmh/trx007. View

Turner H . Health economic analyses of the Global Programme to Eliminate Lymphatic Filariasis. Int Health. 2020; 13(Suppl 1):S71-S74. PMC: 7753169. DOI: 10.1093/inthealth/ihaa095. View

Otoo D, Appiah-Agyekum N, Adzei F . Perceived determinants of implementation success of the neglected tropical diseases programme in Ghana: a qualitative study among programme officers. BMC Public Health. 2021; 21(1):2074. PMC: 8588665. DOI: 10.1186/s12889-021-12096-7. View

Biritwum N, Frempong K, Verver S, Odoom S, Alomatu B, Asiedu O . Progress towards lymphatic filariasis elimination in Ghana from 2000-2016: Analysis of microfilaria prevalence data from 430 communities. PLoS Negl Trop Dis. 2019; 13(8):e0007115. PMC: 6709921. DOI: 10.1371/journal.pntd.0007115. View

Mulebeke R, Wanzira H, Bukenya F, Eganyu T, Collborn K, Elliot R . Implementing population-based mass drug administration for malaria: experience from a high transmission setting in North Eastern Uganda. Malar J. 2019; 18(1):271. PMC: 6688214. DOI: 10.1186/s12936-019-2902-z. View

de Souza D, Yirenkyi E, Otchere J, Biritwum N, Ameme D, Sackey S . Assessing Lymphatic Filariasis Data Quality in Endemic Communities in Ghana, Using the Neglected Tropical Diseases Data Quality Assessment Tool for Preventive Chemotherapy. PLoS Negl Trop Dis. 2016; 10(3):e0004590. PMC: 4814091. DOI: 10.1371/journal.pntd.0004590. View

Kolaczinski J, Robinson E, Finn T . The cost of antibiotic mass drug administration for trachoma control in a remote area of South Sudan. PLoS Negl Trop Dis. 2011; 5(10):e1362. PMC: 3191128. DOI: 10.1371/journal.pntd.0001362. View

Yukich J, Scott C, Silumbe K, Larson B, Bennett A, Finn T . Cost-Effectiveness of Focal Mass Drug Administration and Mass Drug Administration with Dihydroartemisinin-Piperaquine for Malaria Prevention in Southern Province, Zambia: Results of a Community-Randomized Controlled Trial. Am J Trop Med Hyg. 2020; 103(2_Suppl):46-53. PMC: 7416981. DOI: 10.4269/ajtmh.19-0661. View

Goldman A, Brady M, Direny A, Desir L, Oscard R, Vely J . Costs of integrated mass drug administration for neglected tropical diseases in Haiti. Am J Trop Med Hyg. 2011; 85(5):826-33. PMC: 3205627. DOI: 10.4269/ajtmh.2011.10-0635. View

10.

Kastner R, Sicuri E, Stone C, Matwale G, Onapa A, Tediosi F . How much will it cost to eradicate lymphatic filariasis? An analysis of the financial and economic costs of intensified efforts against lymphatic filariasis. PLoS Negl Trop Dis. 2017; 11(9):e0005934. PMC: 5630187. DOI: 10.1371/journal.pntd.0005934. View

11.

Baker M, Krotki K, Sankara D, Trofimovich L, Zoerhoff K, Courtney L . Measuring treatment coverage for neglected tropical disease control programs: analysis of a survey design. Am J Epidemiol. 2013; 178(2):268-75. DOI: 10.1093/aje/kws468. View

12.

Goldman A, Guisinger V, Aikins M, Amarillo M, Belizario V, Garshong B . National mass drug administration costs for lymphatic filariasis elimination. PLoS Negl Trop Dis. 2007; 1(1):e67. PMC: 2041814. DOI: 10.1371/journal.pntd.0000067. View

13.

Turner H, Toor J, Hollingsworth T, Anderson R . Economic Evaluations of Mass Drug Administration: The Importance of Economies of Scale and Scope. Clin Infect Dis. 2017; 66(8):1298-1303. PMC: 5888956. DOI: 10.1093/cid/cix1001. View

14.

Kyaw S, Delmas G, Drake T, Celhay O, Pan-Ngum W, Pukrittayakamee S . Estimating the programmatic cost of targeted mass drug administration for malaria in Myanmar. BMC Public Health. 2021; 21(1):826. PMC: 8082869. DOI: 10.1186/s12889-021-10842-5. View

15.

Mow M, Thean L, Parnaby M, Mani J, Rafai E, Sahukhan A . Costs of mass drug administration for scabies in Fiji. PLoS Negl Trop Dis. 2022; 16(2):e0010147. PMC: 8846527. DOI: 10.1371/journal.pntd.0010147. View

16.

Toor J, Hamley J, Fronterre C, Castano M, Chapman L, Coffeng L . Strengthening data collection for neglected tropical diseases: What data are needed for models to better inform tailored intervention programmes?. PLoS Negl Trop Dis. 2021; 15(5):e0009351. PMC: 8118349. DOI: 10.1371/journal.pntd.0009351. View

17.

Downs P, Bardin L, McFarland D . Modeling the dynamics of incentives in community drug distribution programs. Trends Parasitol. 2014; 30(7):317-9. DOI: 10.1016/j.pt.2014.04.001. View

18.

Gedge L, Bettis A, Bradley M, Hollingsworth T, Turner H . Economic evaluations of lymphatic filariasis interventions: a systematic review and research needs. Parasit Vectors. 2018; 11(1):75. PMC: 5793442. DOI: 10.1186/s13071-018-2616-z. View

19.

Gao B, Saralamba S, Lubell Y, White L, Dondorp A, Aguas R . Determinants of MDA impact and designing MDAs towards malaria elimination. Elife. 2020; 9. PMC: 7185997. DOI: 10.7554/eLife.51773. View

20.

Gyapong J, Owusu I, da-Costa Vroom F, Mensah E, Gyapong M . Elimination of lymphatic filariasis: current perspectives on mass drug administration. Res Rep Trop Med. 2018; 9:25-33. PMC: 6047620. DOI: 10.2147/RRTM.S125204. View