Research Article: National Mass Drug Administration Costs for Lymphatic Filariasis Elimination

Date Published: October 31, 2007

Publisher: Public Library of Science

Author(s): Ann S. Goldman, Victoria H. Guisinger, Moses Aikins, Maria Lourdes E. Amarillo, Vicente Y. Belizario, Bertha Garshong, John Gyapong, Conrad Kabali, Hussein A. Kamal, Sanjat Kanjilal, Dominique Kyelem, Jefrey Lizardo, Mwele Malecela, Godfrey Mubyazi, P. Abdoulaye Nitièma, Reda M. R. Ramzy, Thomas G. Streit, Aaron Wallace, Molly A. Brady, Richard Rheingans, Eric A. Ottesen, Anne C. Haddix, Charles King

Abstract: BackgroundBecause lymphatic filariasis (LF) elimination efforts are hampered by a dearth of economic information about the cost of mass drug administration (MDA) programs (using either albendazole with diethylcarbamazine [DEC] or albendazole with ivermectin), a multicenter study was undertaken to determine the costs of MDA programs to interrupt transmission of infection with LF. Such results are particularly important because LF programs have the necessary diagnostic and treatment tools to eliminate the disease as a public health problem globally, and already by 2006, the Global Programme to Eliminate LF had initiated treatment programs covering over 400 million of the 1.3 billion people at risk.Methodology/Principal FindingsTo obtain annual costs to carry out the MDA strategy, researchers from seven countries developed and followed a common cost analysis protocol designed to estimate 1) the total annual cost of the LF program, 2) the average cost per person treated, and 3) the relative contributions of the endemic countries and the external partners. Costs per person treated ranged from $0.06 to $2.23. Principal reasons for the variation were 1) the age (newness) of the MDA program, 2) the use of volunteers, and 3) the size of the population treated. Substantial contributions by governments were documented – generally 60%–90% of program operation costs, excluding costs of donated medications.Conclusions/SignificanceMDA for LF elimination is comparatively inexpensive in relation to most other public health programs. Governments and communities make the predominant financial contributions to actual MDA implementation, not counting the cost of the drugs themselves. The results highlight the impact of the use of volunteers on program costs and provide specific cost data for 7 different countries that can be used as a basis both for modifying current programs and for developing new ones.

Partial Text: Lymphatic filariasis (LF), commonly known as elephantiasis, is a profoundly disfiguring parasitic disease caused by thread-like nematode worms. The World Health Organization (WHO) places the number of people at risk in 83 countries at 1.307 billion.[1] Globally, the reduced productivity as a consequence of LF disability has been well recognized. The chronic and debilitating burden of LF maintains the cycle of poverty not only in infected individuals but also in entire endemic communities. [2,[3] Indeed, as a disease of poverty, LF is endemic in 43 of the 50 countries classified as least developed nations. [4–6]

Good cost analysis is essential to provide an evidence-based rationale for investing in LF elimination. The key target figure is the cost per person treated. Few results have been available to date, [12,16] and little has been documented about the principal determinants of cost per person treated. This study has defined key activities and input categories and gathered cost information via the standardized cost-analysis studies of seven national LF MDA programs.



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