Seeing beyond 2020: an economic evaluation of contemporary and emerging strategies for elimination of Trypanosoma brucei gambiense

Sutherland, C Simone and M Stone, Christopher and Steinmann, Peter and Tanner, Marcel and Tediosi, Fabrizio (2017) Seeing beyond 2020: an economic evaluation of contemporary and emerging strategies for elimination of Trypanosoma brucei gambiense. The Lancet Global Health, 5 (1). e69-e79. ISSN 0140-6736


Download (1MB) | Preview
Official URL:


Background Trypanosoma brucei (T b) gambiense is targeted to reach elimination as a public health problem by 2020 and full elimination by 2030. To achieve these goals, stakeholders need to consider strategies to accelerate elimination. Hence, we aimed to model several options related to current and emerging methods for case detection, treatment, and vector control across settings to assess cost-eff ectiveness and the probability of elimination. Methods Five intervention strategies were modelled over 30 years for low, moderate, and high transmission settings. Model parameters related to costs, effi cacy, and transmission were based on available evidence and parameter estimation. Outcomes included disability-adjusted life-years (DALYs), costs, and long-term prevalence. Sensitivity analyses were done to calculate the uncertainty of the results. Findings To reach elimination targets for 2020 across all settings, approaches combining case detection, treatment, and vector control would be most eff ective. Elimination in high and moderate transmission areas was probable and costeff ective when strategies included vector control and novel methods, with incremental cost-eff ectiveness ratios (ICERs) ranging from US$400 to $1500 per DALY averted. In low transmission areas, approaches including the newest interventions alone or in combination with tiny targets (vector control) were cost-eff ective, with ICERs of $200 or $1800 per DALY averted, respectively, but only strategies including vector control were likely to lead to elimination. Results of sensitivity analyses showed that allowing for biennial surveillance, reducing vector control maintenance costs, or variations of active surveillance coverage could also be cost-eff ective options for elimination, depending on the setting. Interpretation Although various strategies might lead to elimination of T b gambiense, cost-eff ective approaches will include adoption of emerging technologies and, in some settings, increased surveillance or implementation of vector control.

Item Type: Article
Subjects: WA Public Health
Divisions: Faculty of Medicin
Depositing User: Touba Derakhshande
Date Deposited: 17 Sep 2017 06:24
Last Modified: 17 Sep 2017 06:24

Actions (login required)

View Item View Item