Cost-effectiveness of comparative survey designs for helminth control programs: Post-hoc cost analysis and modelling of the Kenyan national school-based deworming program.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101291488 Publication Model: eCollection Cited Medium: Internet ISSN: 1935-2735 (Electronic) Linking ISSN: 19352727 NLM ISO Abbreviation: PLoS Negl Trop Dis Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Cost-Benefit Analysis* ; Helminthiasis*/economics ; Helminthiasis*/prevention & control ; Helminthiasis*/epidemiology ; Helminthiasis*/drug therapy ; Anthelmintics*/economics ; Anthelmintics*/therapeutic use ; Schools* ; Schistosomiasis*/prevention & control ; Schistosomiasis*/economics ; Schistosomiasis*/epidemiology; Kenya/epidemiology ; Humans ; Child ; Retrospective Studies ; Surveys and Questionnaires ; Helminths ; Animals ; Soil/parasitology ; Adolescent

Background: Soil-transmitted helminths (STH) and schistosomiasis comprise the most wide-spread NTDs globally. Preventative chemotherapy is a cost-effective approach to controlling morbidity of both diseases, but relies on large scale surveys to determine and revise treatment frequency. Availability of detailed information on survey costs is limited despite recent methodological surveying innovations. We micro-costed a survey of STH and schistosomiasis in Kenya, and linked results to precision estimates of competing survey methods to compare cost-efficiency.
Methods: Costs from a 2017 Kenyan parasitological survey were retrospectively analyzed and extrapolated to explore marginal changes when altering survey size, defined by the number of schools sampled and the number of samples taken per school. Subsequent costs were applied to simulated precision estimates of model-based geostatistical (MBG) and traditional survey designs. Cost-precision was calculated for a range of survey sizes per method. Four traditional survey design scenarios, based around WHO guidelines, were selected to act as reference cases for calculating incremental cost-effectiveness ratios (ICERs) for MBG design.
Findings: MBG designed surveys showed improved cost-precision, particularly if optimizing number of schools against samples per school. MBG was found to be more cost-effective under 87 of 92 comparisons to reference cases. This comprised 14 situations where MBG was both cheaper and more precise, 42 which had cost saving with precision trade off (ICERs; $8,915-$344,932 per percentage precision lost); and 31 more precise with increased cost (ICERs; $426-$147,748 per percentage precision gained). The remaining 5 comparisons represented extremes of MBG simulated site selection, unlikely to be applied in practice.
Interpretation: Efficiency gains are possible for deworming surveys when considering cost alone, such as through minimizing sample or analysis costs. However further efficiency maximization is possible when designing surveys using MBG given its improved precision and ability to optimize the balance between number of schools and sample size per school.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2024 Minnery et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

PLoS Negl Trop Dis. 2017 May 26;11(5):e0005599. (PMID: 28552961)
Adv Parasitol. 2006;62:221-61. (PMID: 16647972)
Trends Parasitol. 2017 Jun;33(6):435-443. (PMID: 28187989)
J Infect Dis. 2020 Jun 11;221(Suppl 5):S554-S560. (PMID: 31930383)
Lancet. 2014 Jun 28;383(9936):2253-64. (PMID: 24698483)
Parasit Vectors. 2016 Jan 27;9:38. (PMID: 26813411)
Clin Infect Dis. 2021 Jun 14;72(Suppl 3):S172-S179. (PMID: 33905476)
Parasit Vectors. 2020 Nov 18;13(1):555. (PMID: 33203463)
Parasit Vectors. 2013 Jul 05;6:198. (PMID: 23829767)
Q J Econ. 2016 Nov;131(4):1637-1680. (PMID: 27818531)
Infect Dis Poverty. 2017 Apr 4;6(1):73. (PMID: 28372566)
Parasit Vectors. 2015 Jul 03;8:355. (PMID: 26137945)
Parasit Vectors. 2019 Feb 7;12(1):76. (PMID: 30732642)
Adv Parasitol. 2019;103:151-173. (PMID: 30878057)
Proc Natl Acad Sci U S A. 2021 Apr 6;118(14):. (PMID: 33790017)
Parasit Vectors. 2016 Jan 27;9:31. (PMID: 26813007)

001 International WHO_ World Health Organization

0 (Anthelmintics)
0 (Soil)

Date Created: 20241202 Date Completed: 20241223 Latest Revision: 20250118

20250118

PMC11666021

10.1371/journal.pntd.0011583

39621813