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Table 2 Summary of the identified cost-effectiveness estimates

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

Study Question Target of intervention Target age group/ primary distribution method/ treatment frequency Effects Primary conclusions Source of the costs
Empirical studies       
[29] Cost-effectiveness of albendazole for preventing stunting in Pre-SAC. STH (primarily Ascaris) • Pre-SAC • Prevention of stunting Six monthly albendazole reduces the risk of stunting in Pre-SAC with only a small increase in the expenditure on health care from the payer’s perspective (₹543 Indian Rupees for each case of stunting prevented). Same study
• Mobile teams
• Biannual (six monthly)
[24] Cost-effectiveness of nationwide school-based helminth control in Uganda. STH and Schistosomiasis • SAC • Anaemia cases averted The cost per anaemia case averted was estimated to range from US$1.70–9.51 (depending on the number treated within the different districts (see Table 1)). Same study
• School-based treatment
• Annual
[30] The cost-effectiveness (and cost-benefit) of a project administering deworming and weekly iron-folic acid supplementation to control anaemia in women of child-bearing age. STH and weekly iron supplements • Women of child-bearing age • Anaemia cases averted The cost per anaemia case averted was estimated to be US$4.24. Same study
• Village health workers • A cost benefit ratio based on the labour market productivity for women of reproductive age after removal from anaemia The benefit: cost ratio was estimated to be 6.70:1, i.e. for each dollar invested in the weekly iron supplementation and deworming program the monetary value in terms of productivity was US$6.70.
• Treatment every four months in the first year and every six months thereafter.   
[79] Cost-effectiveness of school-based anthelmintic treatments against anaemia in children. STH and Schistosomiasis • SAC • Anaemia cases averted The cost per anaemia case averted by deworming school children was in the range of US$6–8. [17]
• School-based treatment
• Annual
[31] Comparison of mass, targeted and selective chemotherapy with levamisole for Ascaris control. Ascaris Varied (selective, targeted (to Pre-SAC and SAC), and mass) • Egg reduction per gram of faeces The mass and targeted treatment strategies were considerably more cost-effective then selective treatment. Same study
• Mobile teams Cost per 1000 egg reduction per gram of faeces:
• Three monthly • Selective treatment: ₦5,004,
• Targeted treatment: ₦611,
• Mass treatment: ₦451.
[26] Cost-effectiveness of school-based and community distributed chemotherapy for schistosomiasis and STH control. STH and Schistosomiasis • SAC and targeted adults • Infections averted The estimated cost per infection averted in the treated population (children and adults) was US$2.50. Same study
• Combination
• Annual
[32] The cost-effectiveness of selective health interventions for the control of STH in rural Bangladesh. STH Varied (See Table 1 ) • Reduction of mean egg counts A single round of albendazole to all household members (over the 18 month study) was more cost-effective than chemotherapy to all household members followed by subsequent six monthly chemotherapy to all children. The two regimens involving health education were the least cost-effective. Same study
• Mobile teams • Reduction in prevalence
Varied (one round over 18 months vs six monthly)
[73] Cost-effectiveness (and cost-benefit) of school-based STH and Schistosomiasis control. STH and Schistosomiasis • SAC • DALY Treating SAC is highly cost-effective – US$5 per DALY averted (it was noted that this estimate ignores the indirect benefits for untreated children and adults in the treatment area). Though in areas without schistosomiasis, the cost per DALY averted was estimated to be US$280 – discussed in [42]. [16]
• School-based treatment • Additional years of school participation The cost per additional year of school participation was estimated to be US$3.50 and deworming was found to increase the net present value of wages by over US$30 per treated child.
• Biannual albendazole (annual praziquantel) • Net present value of wages
[80] Effects of the Zanzibar school-based deworming program on iron status of children. STH and Schistosomiasis • SAC • Anaemia cases averted The cost per moderate to severe anaemia case (Hb < 90 g/L) averted over one year (with four monthly mebendazole treatment) was US$3.57, increasing to US$16.30 for the cost per severe anaemia averted (<70 g/L). Unpublished data
• School-based treatment
• Four monthly
Modelling (type of model – see Box 2)       
[48] Cost-effectiveness of school-based Ascaris control (dynamic model). Ascaris • SAC • DALY The analysis indicates that treating SAC is highly cost-effective; US$8 per DALY averted (for a high prevalence community). Unpublished data
• School-based treatment
• Annual
[21] Cost-effectiveness analysis of mass anthelmintic treatment: effects of treatment frequency on Ascaris infection (dynamic model). Ascaris • Mass treatment (i.e. all three age groups) • Unit reductions in mean worm burden If the aim of an intervention is to reduce Ascaris related morbidity using mass treatment, then it is more cost-effective to intervene in higher transmission areas. Furthermore, relatively long intervals between treatments offer the most cost-effective strategy. Unpublished data
• Mobile teams • Infection cases averted
Varied (between every four months and every two years) • Disease cases averted
[44] Options for chemotherapeutic control of Ascaris (dynamic model). Ascaris Varied (mass vs, targeted (to SAC and Pre-SAC)) • Infection cases averted Child-targeted treatment can be more cost-effective than mass treatment in reducing the number of disease cases. The results also imply that (with the assumed circumstances) enhancing coverage is more cost-effective than increasing frequency of treatment. [21] – which was based on unpublished data
• Mobile teams • Disease cases averted
Varied (between every six months and every two years)  
[45] The cost-effectiveness of using different thresholds for determining the treatment frequency (static distribution model). STH • Pre-SAC and SAC • Cost per infected person treated This analysis suggests that a new three-tier treatment for deciding initial treatment frequency (if the combined prevalence is above 40 %, treat all children once a year; above 60 % treat twice a year; and above 80 % treat three times a year), would be more cost-effective than the current WHO recommended thresholds. [16, 17, 22, 24]
• Combination of school-based treatment and Child Health Days • Cost per moderately/heavily infected person treated,
Varied at different thresholds • Cost per diseased person treated
[47] The potential cost-effectiveness of a hookworm vaccine (static model). Hookworm • SAC and non-pregnant women of child-bearing age • DALY A hookworm vaccine may provide not only cost savings, but potential health benefits to both SAC and non-pregnant women of child-bearing age. The most cost-effective strategy may be to combine vaccination with the current drug treatment. [4, 39, 81]
• Combination of school-based treatment and CDDs
• Annual
Policy documents/reports       
[4] Cost-effectiveness of school-based STH control. STH ± Schistosomiasis • SAC • DALY This analysis indicates that treating SAC is highly cost-effective; US$3.41 per DALY averted. (In combination with praziquantel to treat schistosomiasis this changes to US$8–19 per DALY averted.) Not clearly stated
• School-based treatment Though it should be acknowledged that this estimate was found contain a number of errors [43]. GiveWell re- estimated the cost-effectiveness (using a different methodology) and obtained US$30–$80 per DALY averted [43].
• Annual
[34] Cost-effectiveness of treating SAC for STH and schistosomiasis. STH and Schistosomiasis • SAC • DALY This analysis indicates that treating SAC is within the range of being considered highly cost-effective; US$6–33 per DALY averted. Unpublished data
• Mobile teams (via the school)
• Annual
[41] Cost-effectiveness of treating SAC. Not clear • SAC • DALY This analysis indicates that treating SAC is within the range of being considered highly cost-effective; US$15–30 per DALY averted. Not clearly stated
• Not clear
• Not clear
  1. More detailed information regarding the costs (when available) is provided in Table 1. 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)