03070nas a2200241 4500000000100000008004100001260002800042653003900070653002900109653002500138653002300163100001200186700001400198700001600212700001400228700001300242700001400255245017400269856005700443300001200500490000600512520231000518 2016 d bBMJ Specialist Journals10aNeglected tropical diseases (NTDs)10aMass drug administration10aLymphatic filariasis10aCost effectiveness1 aStone C1 aKastner R1 aSteinmann P1 aChitnis N1 aTanner M1 aTediosi F00aModelling the health impact and cost-effectiveness of lymphatic filariasis eradication under varying levels of mass drug administration scale-up and geographic coverage. uhttp://gh.bmj.com/content/bmjgh/1/1/e000021.full.pdf ae0000210 v13 a

Background
A global programme to eliminate lymphatic filariasis (GPELF) is underway, yet two key programmatic features are currently still lacking: (1) the extension of efforts to all lymphatic filariasis (LF) endemic countries, and (2) the expansion of geographic coverage of mass drug administration (MDA) within countries. For varying levels of scale-up of MDA, we assessed the health benefits and the incremental cost-effectiveness ratios (ICERs) associated with LF eradication, projected the potential savings due to decreased morbidity management needs, and estimated potential household productivity gains as a result of reduced LF-related morbidity.

Methods
We extended an LF transmission model to track hydrocele and lymphoedema incidence in order to obtain estimates of the disability adjusted life years (DALYs) averted due to scaling up MDA over a period of 50 years. We then estimated the ICERs and the cost-effectiveness acceptability curves associated with different rates of MDA scale-up. Health systems savings were estimated by considering the averted morbidity, treatment-seeking behaviour and morbidity management costs. Gains in worker productivity were estimated by multiplying estimated working days lost as a result of morbidity with country-specific per-worker agricultural wages.

Results
Our projections indicate that a massive scaling-up of MDA could lead to 4.38 million incremental DALYs averted over a 50-year time horizon compared to a scenario which mirrors current efforts against LF. In comparison to maintaining the current rate of progress against LF, massive scaling-up of MDA—pursuing LF eradication as soon as possible—was most likely to be cost-effective above a willingness to pay threshold of US$71.5/DALY averted. Intensified MDA scale-up was also associated with lower ICERs. Furthermore, this could result in health systems savings up to US$483 million. Extending coverage to all endemic areas could generate additional economic benefits through gains in worker productivity between US$3.4 and US$14.4 billion.

Conclusions
In addition to ethical and political motivations for scaling-up MDA rapidly, this analysis provides economic support for increasing the intensity of MDA programmes.