03112nas a2200397   4500000000100000008004100001260003700042653002400079653005700103653003100160100001500191700001200206700001800218700001300236700001500249700001300264700001400277700001300291700001400304700001300318700001300331700001400344700001300358700002200371700001500393700001100408700001400419700001200433700001400445245013500459856009900594300000900693490000700702520199100709022001402700       2023                            d  bPublic Library of Science (PLoS)10aInfectious Diseases10aPublic Health, Environmental and Occupational Health10aHealth economic evaluation1 aAntillon M1 aHuang C1 aSutherland SA1 aCrump RE1 aBessell PR1 aShaw APM1 aTirados I1 aPicado A1 aBiéler S1 aBrown PE1 aSolano P1 aMbainda S1 aDarnas J1 aWang-Steverding X1 aCrowley EH1 aPeka M1 aTediosi F1 aRock KS1 aMireji PO00aHealth economic evaluation of strategies to eliminate gambiense human African trypanosomiasis in the Mandoul disease focus of Chad  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0011396&type=printable  a1-290 v173 a<p>Human African trypanosomiasis, caused by the gambiense subspecies of Trypanosoma brucei (gHAT), is a deadly parasitic disease transmitted by tsetse. Partners worldwide have stepped up efforts to eliminate the disease, and the Chadian government has focused on the previously high-prevalence setting of Mandoul. In this study, we evaluate the economic efficiency of the intensified strategy that was put in place in 2014 aimed at interrupting the transmission of gHAT, and we make recommendations on the best way forward based on both epidemiological projections and cost-effectiveness. In our analysis, we use a dynamic transmission model fit to epidemiological data from Mandoul to evaluate the cost-effectiveness of combinations of active screening, improved passive screening (defined as an expansion of the number of health posts capable of screening for gHAT), and vector control activities (the deployment of Tiny Targets to control the tsetse vector). For cost-effectiveness analyses, our primary outcome is disease burden, denominated in disability-adjusted life-years (DALYs), and costs, denominated in 2020 US$. Although active and passive screening have enabled more rapid diagnosis and accessible treatment in Mandoul, the addition of vector control provided good value-for-money (at less than $750/DALY averted) which substantially increased the probability of reaching the 2030 elimination target for gHAT as set by the World Health Organization. Our transmission modelling and economic evaluation suggest that the gains that have been made could be maintained by passive screening. Our analysis speaks to comparative efficiency, and it does not take into account all possible considerations; for instance, any cessation of ongoing active screening should first consider that substantial surveillance activities will be critical to verify the elimination of transmission and to protect against the possible importation of infection from neighbouring endemic foci.</p>
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