02986nas a2200253   4500000000100000008004100001260004400042653001800086653002300104653003100127100002000158700001400178700001500192700001300207700001100220700001400231700001400245245010900259856011000368300000900478490000700487520222400494022001402718       2023                            d  bSpringer Science and Business Media LLC10aHealth Policy10acost-effectiveness10aIntegrated case management1 aGodwin-Akpan TG1 aDiaconu K1 aEdmiston M1 aSmith JS1 aSosu F1 aWeiland S1 aKollie KK00aAssessing the cost-effectiveness of integrated case management of Neglected Tropical Diseases in Liberia  uhttps://bmchealthservres.biomedcentral.com/counter/pdf/10.1186/s12913-023-09685-0.pdf?pdf=button%20sticky  a1-100 v233 a<p><strong>Background:</strong> In 2017, Liberia became one of the first countries in the African region to develop and implement a national strategy for integrated case management of Neglected Tropical Diseases (CM-NTDs), specifically Buruli ulcer, leprosy, lymphatic filariasis morbidities, and yaws. Implementing this plan moves the NTD program from many countries' fragmented (vertical) disease management. This study explores to what extent an integrated approach offers a cost-effective investment for national health systems.</p>

<p><strong>Methods:</strong> This study is a mixed-method economic evaluation that explores the cost-effectiveness of the integrated CM-NTDs approach compared to the fragmented (vertical) disease management. Primary data were collected from two integrated intervention counties and two non-intervention counties to determine the relative cost-effectiveness of the integrated program model vs. fragmented (vertical) care. Data was sourced from the NTDs program annual budgets and financial reports for integrated CM-NTDs and Mass Drug Administration (MDA) to determine cost drivers and effectiveness.</p>

<p><strong>Results:</strong> The total cost incurred by the integrated CM-NTD approach from 2017 to 2019 was US$ 789,856.30, with the highest percentage of costs for program staffing and motivation (41.8%), followed by operating costs (24.8%). In the two counties implementing fragmented (vertical) disease management, approximately US$ 325,000 was spent on the diagnosis of 84 persons and the treatment of twenty-four persons suffering from NTDs. While 2.5 times as much was spent in integrated counties, 9–10 times more patients were diagnosed and treated.</p>

<p><strong>Conclusions:</strong> The cost of a patient being diagnosed under the fragmented (vertical) implementation is five times higher than integrated CM-NTDs, and providing treatment is ten times as costly. Findings indicate that the integrated CM-NTDs strategy has achieved its primary objective of improved access to NTD services. The success of implementing an integrated CM-NTDs approach in Liberia, presented in this paper, demonstrates that NTD integration is a cost-minimizing solution.</p>
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