Cost-effectiveness of vector control for supplementing mass drug administration for eliminating lymphatic filariasis in India.
<h4>Background/methodology</h4>Despite progress using mass drug administration (MDA), lymphatic filariasis (LF) remains a major public health issue in India. Vector control could potentially augment MDA towards LF elimination. We conducted a cost-effectiveness analysis of MDA alone and M...
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| Format: | Article |
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Public Library of Science (PLoS)
2024-12-01
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| Series: | PLoS Neglected Tropical Diseases |
| Online Access: | https://doi.org/10.1371/journal.pntd.0011835 |
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| author | Donald S Shepard Aung K Lwin Sunish I Pulikkottil Mariapillai Kalimuthu Natarajan Arunachalam Brij K Tyagi Graham B White |
| author_facet | Donald S Shepard Aung K Lwin Sunish I Pulikkottil Mariapillai Kalimuthu Natarajan Arunachalam Brij K Tyagi Graham B White |
| author_sort | Donald S Shepard |
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| description | <h4>Background/methodology</h4>Despite progress using mass drug administration (MDA), lymphatic filariasis (LF) remains a major public health issue in India. Vector control could potentially augment MDA towards LF elimination. We conducted a cost-effectiveness analysis of MDA alone and MDA together with vector control single (VCS) modality or vector control integrated (VCI) modalities. Data came from historical controls and a three-arm cluster randomized trial of 36 villages at risk of LF transmission in Tamil Nadu, India. The arms were: MDA alone (the standard of care); MDA plus VCS (expanded polystyrene beads covering the water surface in wells and cesspits to suppress the filariasis vector mosquito Culex quinquefasciatus); and MDA plus VCI (VCS plus insecticidal pyrethroid-impregnated curtains [over windows, doors, and eaves). Economic costs in 2010 US$ combined government and community inputs from household to state levels. Outcomes were controlled microfilaria prevalence (MfP) and antigen prevalence (AgP) to conventional elimination targets (MfP<1% or AgP<2%) from 2010 to 2013, and modeled disability adjusted life years (DALYs) averted.<h4>Principal findings</h4>The estimated annual economic cost per resident was US$0.53 for MDA alone, US$1.02 for VCS, and US$1.83 for VCI. With MDA offered in all arms, all arms reduced LF prevalence substantially from 2010 to 2013. MDA proved highly cost effective at $112 per DALY averted, a very small (8%) share of India's then per capita Gross Domestic Product. Progress towards elimination was comparable across all three study arms.<h4>Conclusions</h4>The well-functioning MDA program proved effective and very cost-effective for eliminating LF, leaving little scope for further improvement. Supplementary vector control demonstrated no statistically significant additional benefit on MfP or AgP in this trial. |
| format | Article |
| id | doaj-art-70d5fd6fa1f64da085d14d3cfd90e886 |
| institution | Kabale University |
| issn | 1935-2727 1935-2735 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS Neglected Tropical Diseases |
| spelling | doaj-art-70d5fd6fa1f64da085d14d3cfd90e8862025-01-21T05:31:48ZengPublic Library of Science (PLoS)PLoS Neglected Tropical Diseases1935-27271935-27352024-12-011812e001183510.1371/journal.pntd.0011835Cost-effectiveness of vector control for supplementing mass drug administration for eliminating lymphatic filariasis in India.Donald S ShepardAung K LwinSunish I PulikkottilMariapillai KalimuthuNatarajan ArunachalamBrij K TyagiGraham B White<h4>Background/methodology</h4>Despite progress using mass drug administration (MDA), lymphatic filariasis (LF) remains a major public health issue in India. Vector control could potentially augment MDA towards LF elimination. We conducted a cost-effectiveness analysis of MDA alone and MDA together with vector control single (VCS) modality or vector control integrated (VCI) modalities. Data came from historical controls and a three-arm cluster randomized trial of 36 villages at risk of LF transmission in Tamil Nadu, India. The arms were: MDA alone (the standard of care); MDA plus VCS (expanded polystyrene beads covering the water surface in wells and cesspits to suppress the filariasis vector mosquito Culex quinquefasciatus); and MDA plus VCI (VCS plus insecticidal pyrethroid-impregnated curtains [over windows, doors, and eaves). Economic costs in 2010 US$ combined government and community inputs from household to state levels. Outcomes were controlled microfilaria prevalence (MfP) and antigen prevalence (AgP) to conventional elimination targets (MfP<1% or AgP<2%) from 2010 to 2013, and modeled disability adjusted life years (DALYs) averted.<h4>Principal findings</h4>The estimated annual economic cost per resident was US$0.53 for MDA alone, US$1.02 for VCS, and US$1.83 for VCI. With MDA offered in all arms, all arms reduced LF prevalence substantially from 2010 to 2013. MDA proved highly cost effective at $112 per DALY averted, a very small (8%) share of India's then per capita Gross Domestic Product. Progress towards elimination was comparable across all three study arms.<h4>Conclusions</h4>The well-functioning MDA program proved effective and very cost-effective for eliminating LF, leaving little scope for further improvement. Supplementary vector control demonstrated no statistically significant additional benefit on MfP or AgP in this trial.https://doi.org/10.1371/journal.pntd.0011835 |
| spellingShingle | Donald S Shepard Aung K Lwin Sunish I Pulikkottil Mariapillai Kalimuthu Natarajan Arunachalam Brij K Tyagi Graham B White Cost-effectiveness of vector control for supplementing mass drug administration for eliminating lymphatic filariasis in India. PLoS Neglected Tropical Diseases |
| title | Cost-effectiveness of vector control for supplementing mass drug administration for eliminating lymphatic filariasis in India. |
| title_full | Cost-effectiveness of vector control for supplementing mass drug administration for eliminating lymphatic filariasis in India. |
| title_fullStr | Cost-effectiveness of vector control for supplementing mass drug administration for eliminating lymphatic filariasis in India. |
| title_full_unstemmed | Cost-effectiveness of vector control for supplementing mass drug administration for eliminating lymphatic filariasis in India. |
| title_short | Cost-effectiveness of vector control for supplementing mass drug administration for eliminating lymphatic filariasis in India. |
| title_sort | cost effectiveness of vector control for supplementing mass drug administration for eliminating lymphatic filariasis in india |
| url | https://doi.org/10.1371/journal.pntd.0011835 |
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