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Table 1 Overview of the identified costs

From: Cost and cost-effectiveness of soil-transmitted helminth treatment programmes: systematic review and research needs

Study

Country

Target of intervention

Primary distribution method

Age-groups targeted

Treatment frequency

Perspective explicitly stated

Year of price

Currency

Economic costs collected

Costs itemised

Results

High

           

[24]

Uganda

STH and Schistosomiasis

School-based

SAC

Annual

Y (Service provider)

2005

US$

Y

Y

The overall economic cost per child treated in the six districts was US$0.54, which ranged between the districts from US$0.41 to US$0.91 (delivery costs: US$0.19–0.69). The overall financial cost per child treated was US$0.39.

[25]

Haiti

STH and Lymphatic filariasis

Combination

Mass treatment (all persons greater than two years of age)

Annual

Y (Service provider)

2008–2009

US$

Y

Y

The economic cost was US$0.64 per person treated, which included the value of the donated drugs. The programme cost (which excluded the value of the donated drugs) was US$0.42 per person treated.

[26]

Niger

STH and Schistosomiasis

Combination

SAC and targeted adults

Annual

N

2005

US$

Y

Y

The total economic delivery cost of the school-based and community-based treatment was US$0.76, and US$0.46 respectively. Including only the programme costs and the values change to US$0.47 and US$0.41 respectively. The average drug (albendazole and praziquantel) cost was US$0.28 per treatment; not clear which results included the drugs costs.

[27]

Niger

STH, Schistosomiasis, Lymphatic filariasis, and Trachoma

Combination

SAC and adults (not clear if Pre-SAC were treated)

Annual

N

2009

US$

Y

Y

The average economic cost of integrated preventive chemotherapy was US$0.19 (excluding drug costs). The average financial cost per treatment of the vertical schistosomiasis and STH programme (before the NTD programmes integrated) was US$0.10.

Medium

           

[19]

Lao PDR

STH within an immunisation and vitamin A supplementation campaign

Child Health Days

Pre SAC and women of child-bearing age (SAC were targeted though the national deworming campaign)

Annual

N

2009

US$

Y

Y

The incremental cost of adding deworming into the national immunisation campaign was US$0.03 per treatment (delivery costs: US$0.007). This is compared to US$0.23 per treatment for the vertical national school-based deworming campaign (targeting SAC).

[20]

Nigeria

STH, Schistosomiasis, Lymphatic filariasis, and Onchocerciasis

Community drug distributers (CDDs)

SAC for praziquantel and SAC and adults for ivermectin/albendazole

Annual

Y (Service provider)

2008–2009

US$

N

Y

In 2008, eight local government areas received a single round of ivermectin and albendazole followed at least one week later by praziquantel to SAC. The following year, a single round of triple drug administration was given. When using the latter the programmatic costs for MDA (not including drug and overhead costs), were reduced by 41.1 % (from US$0.078 to US$0.046 per treatment).

[22]

Ethiopia

STH

Child Health Days

Pre-SAC

One round

N

2006

US$

Y

Partial

The average cost per child reached by the Child Health Day programme was US$0.56 (per round) of which deworming was estimated to represent 29 % of the cost (US$0.162).

[23]

Uganda

STH within an vitamin A supplementation campaign

Child Health Days

SAC and Pre-SAC

One round

Y (Service provider)

2010

US$

Y

Partial#

The average cost per child reached by the Child Health Day programme was US$0.22 (per round) – including the cost of vitamin A.

# Although detailed itemised costs were provided they pertained to the Child Health Day programme as a whole (the purpose of that study) and not the deworming arm.

[21]

Based on data from Montserrat

STH

Mobile teams

Mass treatment

Not applicable

Y (Service provider)

1988

US$

N

Y

Presented in a cost menu.

[17]

Tanzania

STH

School-based

SAC

One round

Y (Service provider)

1996

US$

Y

Partial

See [16]

[16]

Ghana and Tanzania

STH

School-based

SAC

One round

Y (Service provider)

1996

US$

Y

Partial

The economic cost per treatment in Ghana, and Tanzania was US$0.27, and US$0.26 (delivery: US$0.07, and US$0.06), respectively. The financial cost per person treated in Ghana, and Tanzania was US$0.24, and US$0.023 (delivery: US$0.04, and US$0.03), respectively.

† Note that the results are artificially low because they did not include the external costs of the UK-based coordinating centre [39].

Low

           

[37]

Seychelles

STH and other intestinal parasitic infections

Schools and (crèches for 3–5 year olds)

SAC and Pre-SAC (3–5 year olds)

Four monthly

N

1993–1994

US$

N

Y

The financial cost of the programme in 1994 was estimated to be US$0.40 per person treated; unclear if the start-up costs from 1993 were included or if this is a cost per round or per year.

[29]

India

STH (primarily Ascaris)

Mobile teams

Pre-SAC

Biannual (six monthly)

Y (Patient)

1995–1997

Indian Rupees (₹)

N

N

The incremental financial cost of treating 5,000 Pre-SAC with six monthly albendazole for two years was ₹122,091 (including the drug cost of ₹20 per dose).

[30]

Vietnam

STH (within a weekly iron-folic acid supplementation campaign)

Village health workers

Non-pregnant women of child-bearing age

four monthly in the first year and six monthly thereafter

Partial

2010

US$

N

Partial

The yearly financial cost of the programme was US$0.76 per woman treated; including the cost of weekly iron supplementation.

[74]

Egypt

STH, Schistosomiasis and other intestinal parasitic infections

Mobile teams

SAC

Annual

N

2000

US$

N

Partial

The incremental financial cost of STH control was US$0.07 per treatment (delivery costs: US$0.03), when integrated into the national schistosomiasis control programme.

[33]

Burundi

STH, Schistosomiasis and other intestinal parasitic infections

Mobile teams (via the school)

SAC (selective treatment)

Annual

N

1984–1992

US$

N

Partial

The financial cost per person protected in 1984–1985, 1989–1990, and 1991–1992 was US$2.7, US$1.2, and US$0.70, respectively. The reported costs per treatment related to only schistosomiasis.

[75]

Burkina Faso

STH and Schistosomiasis

Combination

SAC

One round

N

2004–2005

US$

N

Y

The financial cost per child treated was US$0.308 for the school-based component and US$0.33 for the community-based component (delivery: US$0.084, US$0.107 respectively).

[39]

Based on data from Tanzania

STH and Schistosomiasis

School-based

SAC

Not applicable

N

Not clear

US$

N

Y

Presented in a cost menu [39].

[31]

Nigeria

Ascaris

Mobile teams

Varied: A) selective treatment (treating the 20 % most heavily infected), B) targeted treatment to Pre-SAC and SAC and C) mass treatment to all (excluding <1 and pregnant women)

Three monthly

N

1989

Naira

N

Partial

The total financial costs (and delivery costs) were; A) Selective treatment: 2,491 (12,414), B) Targeted treatment: 3,956 (3,550), C) Mass treatment: 4,701 (3,809).

           

(Total costs are shown as it is misleading to compare the cost per treatment for a selective treatment strategy to that of mass/targeted treatment.)

[18]

Uganda

STH

School-based

SAC

Annual

Y (Service provider)

2004

US$

N

Partial

The estimated financial cost per treatment in the four districts ranged from US$0.063 to S$0.105 (delivery costs: US$0.04 to US$0.08). ‡ These cost estimates do not include the start-up costs or those incurred at the central level.

[32]

Bangladesh

STH

Mobile teams

First dose mass (i.e. children and household members) other doses just children (2–8 years old)

Varied: See legend (Treatment frequency Note 1)

Y (Service provider)

Not clear

Takas (৳)

N

Partial

Project cost per household: A) ৳301 B) ৳1,897 C) ৳332 D) ৳1,909

[28]

Nepal

STH within an vitamin A supplementation campaign

Child Health Days

Pre-SAC

Biannual

NA

NA

US$

NA

NA

An additional US$80,000 (4 % of the total cost of the vitamin A campaign) covered the cost of biannual deworming).

[62]

Zanzibar

STH and Schistosomiasis

School-based (“sibling approach*”)

Non-enrolled SAC

One round

N

2000

US$

N

N

The costs linked to drug transport, training and drug administration were not increased by the inclusion of non-enrolled children. Therefore, the additional financial cost of including non-enrolled SAC using the sibling approach” consisted only of the extra drugs treatments needed. It was noted that a negligible additional cost may be incurred for storage of leftover drugs.

*Enrolled children invited tell parents, siblings and friends of school-age when the next deworming day is.

[76]

Myanmar

STH

School-based

SAC

One round

N

Not clear

US$

N

Y

A crude calculation estimated that the financial cost per treatment was approximately US$0.05 (delivery: US$0.03).

[77]

Vietnam

STH

School-based

SAC

Annual

N

Not clear

US$

N

Y

The financial costs per treatment in 2000–2001, 2002–2003, and 2005–2006 were US$0.71, US$0.11, and US$0.03 (delivery: US$0.683, US$0.0857 and US$0.0128) respectively.

[78]

Yemen

STH and Schistosomiasis

Combination (school-based for SAC and CDDs/health workers for adults and non-enrolled SAC)

SAC and adults

Annual

N

2008–2009

US$

N

Y

The financial cost per person treated in 2008, and 2009 was US$0.79, and US$0.66 (delivery: US$0.44 and US$0.37), respectively.

[36]

Lao PDR

STH

School-based

SAC

Biannual

N

2007

US$

N

Y

In the provinces treating twice a year the financial cost (capital costs not annualised) was US$0.23 per child per year, while in provinces treating once a year the cost was US$0.17 per child per year.

[35]

Cambodia

STH

School-based

SAC

Biannual

N

2003–2004

US$

N

Y

The financial cost per treatment in 2003 and 2004 was US$0.122, and US$0.057 (delivery: US$0.096 and US$0.033), respectively.

[34]

Notional

STH and Schistosomiasis

Mobile teams (via the school)

SAC

Annual

N

Not clear

US$

N

N

Treating for ten years would cost between US$8 and US$18 per child (US$0.8- US$1.8 per year). (Assumes that four treatments of praziquantel and eight of albendazole are given in the ten year period.

  1. The costing studies were grouped into three categories, low, medium and high, reflecting their applicability for use in forthcoming economic evaluations. This grouping was based on three factors; 1) whether the cost year and currency exchange rates were clearly stated, 2) economic costs collected, and 3) detailed itemised costs reported for the STH control component of the programme (i.e. no major costs sources were excluded). Those that provided/did all three were grouped into high, two into medium, and only one or none into low. CDDs; Community drug distributers, Pre-SAC; Pre-school aged children, SAC; School aged children. School-based delivery systems were defined as those utilising teachers and other school officials (not just distributing the drugs at the school NA: Not available. Treatment frequency Note 1: Varied; A) Chemotherapy to all household members at the start of the study, B) same as Group A, but with regular health education, C) Chemotherapy to all household members and subsequent six monthly chemotherapy to all children, D) same as Group C but also with regular health education