Cost and cost-effectiveness analysis of mass drug administration compared to school-based targeted preventive chemotherapy for hookworm control in Dak Lak province, Vietnam

John Paul Caesar delos Trinos; Dinh Ng-Nguyen; Luc E. Coffeng; Clare E.F. Dyer; Naomi Clarke; Rebecca Traub; Kate Halton; Virginia Wiseman; Caroline Watts; Susana Vaz Nery

doi:10.1016/j.lanwpc.2023.100913

Cost and cost-effectiveness analysis of mass drug administration compared to school-based targeted preventive chemotherapy for hookworm control in Dak Lak province, Vietnam

John Paul Caesar delos Trinos^*
, Dinh Ng-Nguyen
, Luc E. Coffeng
, Clare E.F. Dyer
, Naomi Clarke
, Rebecca Traub
, Kate Halton
, Virginia Wiseman
, Caroline Watts
, Susana Vaz Nery

^*Corresponding author for this work

Public Health

University of New South Wales
University of the Philippines
Tay Nguyen University
University of Melbourne
Queensland University of Technology
London School of Hygiene and Tropical Medicine
The University of Sydney

Research output: Contribution to journal › Article › Academic › peer-review

10 Citations (Scopus)

88 Downloads (Pure)

Abstract

Background:

School-based targeted preventive chemotherapy (PC), the main strategy for soil-transmitted helminths (STH) control, excludes other at-risk populations including adults and preschool children. Mass drug administration (MDA), covering all age groups, would bring additional health benefits but also requires greater investment. This cost survey and cost-effectiveness analysis compared MDA with school-based targeted PC for STH control in Dak Lak, Vietnam, where STH are endemic.

Methods:

A cost survey was conducted in 2020 to estimate the total and per person economic and financial cost of each strategy. Monte Carlo simulation accounted for uncertainty in cost estimates. The primary effectiveness measure was hookworm-related disability-adjusted life years (DALYs) averted, and secondary measures were hookworm infection-years averted and moderate-to-heavy intensity hookworm infection-years averted. A Markov model was used to determine the incremental cost-effectiveness ratio (ICER) of MDA compared to school-based targeted PC using a government payer perspective and a ten-year time horizon. One-way and probabilistic sensitivity analyses (PSA) were performed. Costs are reported in 2020 USD ($).

Findings:

The economic cost per person was $0.27 for MDA and $0.43 for school-based targeted PC. MDA in Dak Lak will cost $472,000 per year, while school-based targeted PC will cost $117,000. Over 10 years, MDA is estimated to avert an additional 121,465 DALYs; 4,019,262 hookworm infection-years, and 765,844 moderate-to-heavy intensity hookworm infection-years compared to school-based targeted PC. The ICER was $28.55 per DALY averted; $0.87 per hookworm infection-years averted, and $4.54 per moderate-to-heavy intensity hookworm infection-years averted. MDA was cost-effective in all PSA iterations.

Interpretation:

In areas where hookworm predominates and adults suffer a significant burden of infection, MDA is cost effective compared to school based targeted PC and is the best strategy to achieve global targets. \

Original language	English
Article number	100913
Journal	The Lancet Regional Health - Western Pacific
Volume	41
DOIs	https://doi.org/10.1016/j.lanwpc.2023.100913
Publication status	Published - Dec 2023

Bibliographical note

Funding Information:
The project was funded by the National Health and Medical Research Council (NHMRC) of Australia (Project Grant APP1139561) and JPCDT was supported by a UNSW Scientia PhD Scholarship.

Publisher Copyright:
© 2023 The Authors

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

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Cost and cost-effectiveness analysis of mass drug administration compared to school-based targeted preventive chemotherapy for hookworm control in Dak Lak province, VietnamFinal published version, 1.1 MBLicence: CC BY-NC-ND

Cite this

Caesar delos Trinos, J. P., Ng-Nguyen, D., Coffeng, L. E., Dyer, C. E. F., Clarke, N., Traub, R., Halton, K., Wiseman, V., Watts, C., & Nery, S. V. (2023). Cost and cost-effectiveness analysis of mass drug administration compared to school-based targeted preventive chemotherapy for hookworm control in Dak Lak province, Vietnam. The Lancet Regional Health - Western Pacific, 41, Article 100913. https://doi.org/10.1016/j.lanwpc.2023.100913

@article{dd9f81c4288a47b8b08eaeed9f9394fb,

title = "Cost and cost-effectiveness analysis of mass drug administration compared to school-based targeted preventive chemotherapy for hookworm control in Dak Lak province, Vietnam",

abstract = "Background: School-based targeted preventive chemotherapy (PC), the main strategy for soil-transmitted helminths (STH) control, excludes other at-risk populations including adults and preschool children. Mass drug administration (MDA), covering all age groups, would bring additional health benefits but also requires greater investment. This cost survey and cost-effectiveness analysis compared MDA with school-based targeted PC for STH control in Dak Lak, Vietnam, where STH are endemic. Methods: A cost survey was conducted in 2020 to estimate the total and per person economic and financial cost of each strategy. Monte Carlo simulation accounted for uncertainty in cost estimates. The primary effectiveness measure was hookworm-related disability-adjusted life years (DALYs) averted, and secondary measures were hookworm infection-years averted and moderate-to-heavy intensity hookworm infection-years averted. A Markov model was used to determine the incremental cost-effectiveness ratio (ICER) of MDA compared to school-based targeted PC using a government payer perspective and a ten-year time horizon. One-way and probabilistic sensitivity analyses (PSA) were performed. Costs are reported in 2020 USD (\$). Findings: The economic cost per person was \$0.27 for MDA and \$0.43 for school-based targeted PC. MDA in Dak Lak will cost \$472,000 per year, while school-based targeted PC will cost \$117,000. Over 10 years, MDA is estimated to avert an additional 121,465 DALYs; 4,019,262 hookworm infection-years, and 765,844 moderate-to-heavy intensity hookworm infection-years compared to school-based targeted PC. The ICER was \$28.55 per DALY averted; \$0.87 per hookworm infection-years averted, and \$4.54 per moderate-to-heavy intensity hookworm infection-years averted. MDA was cost-effective in all PSA iterations. Interpretation: In areas where hookworm predominates and adults suffer a significant burden of infection, MDA is cost effective compared to school based targeted PC and is the best strategy to achieve global targets. \textbackslash{}",

author = "\{Caesar delos Trinos\}, \{John Paul\} and Dinh Ng-Nguyen and Coffeng, \{Luc E.\} and Dyer, \{Clare E.F.\} and Naomi Clarke and Rebecca Traub and Kate Halton and Virginia Wiseman and Caroline Watts and Nery, \{Susana Vaz\}",

note = "Funding Information: The project was funded by the National Health and Medical Research Council (NHMRC) of Australia (Project Grant APP1139561) and JPCDT was supported by a UNSW Scientia PhD Scholarship. Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2023",

month = dec,

doi = "10.1016/j.lanwpc.2023.100913",

language = "English",

volume = "41",

journal = "The Lancet Regional Health - Western Pacific",

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Caesar delos Trinos, JP, Ng-Nguyen, D, Coffeng, LE, Dyer, CEF, Clarke, N, Traub, R, Halton, K, Wiseman, V, Watts, C & Nery, SV 2023, 'Cost and cost-effectiveness analysis of mass drug administration compared to school-based targeted preventive chemotherapy for hookworm control in Dak Lak province, Vietnam', The Lancet Regional Health - Western Pacific, vol. 41, 100913. https://doi.org/10.1016/j.lanwpc.2023.100913

Cost and cost-effectiveness analysis of mass drug administration compared to school-based targeted preventive chemotherapy for hookworm control in Dak Lak province, Vietnam. / Caesar delos Trinos, John Paul; Ng-Nguyen, Dinh; Coffeng, Luc E. et al.
In: The Lancet Regional Health - Western Pacific, Vol. 41, 100913, 12.2023.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Cost and cost-effectiveness analysis of mass drug administration compared to school-based targeted preventive chemotherapy for hookworm control in Dak Lak province, Vietnam

AU - Caesar delos Trinos, John Paul

AU - Ng-Nguyen, Dinh

AU - Coffeng, Luc E.

AU - Dyer, Clare E.F.

AU - Clarke, Naomi

AU - Traub, Rebecca

AU - Halton, Kate

AU - Wiseman, Virginia

AU - Watts, Caroline

AU - Nery, Susana Vaz

N1 - Funding Information: The project was funded by the National Health and Medical Research Council (NHMRC) of Australia (Project Grant APP1139561) and JPCDT was supported by a UNSW Scientia PhD Scholarship. Publisher Copyright: © 2023 The Authors

PY - 2023/12

Y1 - 2023/12

N2 - Background: School-based targeted preventive chemotherapy (PC), the main strategy for soil-transmitted helminths (STH) control, excludes other at-risk populations including adults and preschool children. Mass drug administration (MDA), covering all age groups, would bring additional health benefits but also requires greater investment. This cost survey and cost-effectiveness analysis compared MDA with school-based targeted PC for STH control in Dak Lak, Vietnam, where STH are endemic. Methods: A cost survey was conducted in 2020 to estimate the total and per person economic and financial cost of each strategy. Monte Carlo simulation accounted for uncertainty in cost estimates. The primary effectiveness measure was hookworm-related disability-adjusted life years (DALYs) averted, and secondary measures were hookworm infection-years averted and moderate-to-heavy intensity hookworm infection-years averted. A Markov model was used to determine the incremental cost-effectiveness ratio (ICER) of MDA compared to school-based targeted PC using a government payer perspective and a ten-year time horizon. One-way and probabilistic sensitivity analyses (PSA) were performed. Costs are reported in 2020 USD ($). Findings: The economic cost per person was $0.27 for MDA and $0.43 for school-based targeted PC. MDA in Dak Lak will cost $472,000 per year, while school-based targeted PC will cost $117,000. Over 10 years, MDA is estimated to avert an additional 121,465 DALYs; 4,019,262 hookworm infection-years, and 765,844 moderate-to-heavy intensity hookworm infection-years compared to school-based targeted PC. The ICER was $28.55 per DALY averted; $0.87 per hookworm infection-years averted, and $4.54 per moderate-to-heavy intensity hookworm infection-years averted. MDA was cost-effective in all PSA iterations. Interpretation: In areas where hookworm predominates and adults suffer a significant burden of infection, MDA is cost effective compared to school based targeted PC and is the best strategy to achieve global targets. \

AB - Background: School-based targeted preventive chemotherapy (PC), the main strategy for soil-transmitted helminths (STH) control, excludes other at-risk populations including adults and preschool children. Mass drug administration (MDA), covering all age groups, would bring additional health benefits but also requires greater investment. This cost survey and cost-effectiveness analysis compared MDA with school-based targeted PC for STH control in Dak Lak, Vietnam, where STH are endemic. Methods: A cost survey was conducted in 2020 to estimate the total and per person economic and financial cost of each strategy. Monte Carlo simulation accounted for uncertainty in cost estimates. The primary effectiveness measure was hookworm-related disability-adjusted life years (DALYs) averted, and secondary measures were hookworm infection-years averted and moderate-to-heavy intensity hookworm infection-years averted. A Markov model was used to determine the incremental cost-effectiveness ratio (ICER) of MDA compared to school-based targeted PC using a government payer perspective and a ten-year time horizon. One-way and probabilistic sensitivity analyses (PSA) were performed. Costs are reported in 2020 USD ($). Findings: The economic cost per person was $0.27 for MDA and $0.43 for school-based targeted PC. MDA in Dak Lak will cost $472,000 per year, while school-based targeted PC will cost $117,000. Over 10 years, MDA is estimated to avert an additional 121,465 DALYs; 4,019,262 hookworm infection-years, and 765,844 moderate-to-heavy intensity hookworm infection-years compared to school-based targeted PC. The ICER was $28.55 per DALY averted; $0.87 per hookworm infection-years averted, and $4.54 per moderate-to-heavy intensity hookworm infection-years averted. MDA was cost-effective in all PSA iterations. Interpretation: In areas where hookworm predominates and adults suffer a significant burden of infection, MDA is cost effective compared to school based targeted PC and is the best strategy to achieve global targets. \

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DO - 10.1016/j.lanwpc.2023.100913

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AN - SCOPUS:85173476279

SN - 2666-6065

VL - 41

JO - The Lancet Regional Health - Western Pacific

JF - The Lancet Regional Health - Western Pacific

M1 - 100913

ER -

Cost and cost-effectiveness analysis of mass drug administration compared to school-based targeted preventive chemotherapy for hookworm control in Dak Lak province, Vietnam

Abstract

Bibliographical note

UN SDGs

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