Costs of community-wide mass drug administration and school-based deworming for soil-transmitted helminths: evidence from a randomised controlled trial in Benin, India and Malawi
Objectives Current guidelines for the control of soil-transmitted helminths (STH) recommend deworming children and other high-risk groups, primarily using school-based deworming (SBD) programmes. However, targeting individuals of all ages through community-wide mass drug administration (cMDA) may in...
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BMJ Publishing Group
2022-07-01
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| author | Judd Walson ROBIN BAILEY Katya Galactionova Maitreyi Sahu Samuel Paul Gideon Saravanakumar Puthupalayam Kaliappan Chloe Morozoff Sitara Swarna Rao Ajjampur Khumbo Kalua Euripide Avokpaho Moudachirou Ibikounle Arianna Rubin Means James Simwanza Wongani Lungu Parfait Houngbegnon Adrian J F Luty Rachel Pullan |
| author_facet | Judd Walson ROBIN BAILEY Katya Galactionova Maitreyi Sahu Samuel Paul Gideon Saravanakumar Puthupalayam Kaliappan Chloe Morozoff Sitara Swarna Rao Ajjampur Khumbo Kalua Euripide Avokpaho Moudachirou Ibikounle Arianna Rubin Means James Simwanza Wongani Lungu Parfait Houngbegnon Adrian J F Luty Rachel Pullan |
| author_sort | Judd Walson |
| collection | DOAJ |
| description | Objectives Current guidelines for the control of soil-transmitted helminths (STH) recommend deworming children and other high-risk groups, primarily using school-based deworming (SBD) programmes. However, targeting individuals of all ages through community-wide mass drug administration (cMDA) may interrupt STH transmission in some settings. We compared the costs of cMDA to SBD to inform decision-making about future updates to STH policy.Design We conducted activity-based microcosting of cMDA and SBD for 2 years in Benin, India and Malawi within an ongoing cMDA trial.Setting Field sites and collaborating research institutions.Primary and secondary outcomes We calculated total financial and opportunity costs and costs per treatment administered (unit costs in 2019 USD ($)) from the service provider perspective, including costs related to community drug distributors and other volunteers.Results On average, cMDA unit costs were more expensive than SBD in India ($1.17 vs $0.72) and Malawi ($2.26 vs $1.69), and comparable in Benin ($2.45 vs $2.47). cMDA was more expensive than SBD in part because most costs (~60%) were ‘supportive costs’ needed to deliver treatment with high coverage, such as additional supervision and electronic data capture. A smaller fraction of cMDA costs (~30%) was routine expenditures (eg, drug distributor allowances). The remaining cMDA costs (~10%) were opportunity costs of staff and volunteer time. A larger percentage of SBD costs was opportunity costs for teachers and other government staff (between ~25% and 75%). Unit costs varied over time and were sensitive to the number of treatments administered.Conclusions cMDA was generally more expensive than SBD. Accounting for local staff time (volunteers, teachers, health workers) in community programmes is important and drives higher cost estimates than commonly recognised in the literature. Costs may be lower outside of a trial setting, given a reduction in supportive costs used to drive higher treatment coverage and economies of scale.Trial registration number NCT03014167. |
| format | Article |
| id | doaj-art-be83fae04337454c983c50be655b3ef2 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-07-01 |
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| spelling | doaj-art-be83fae04337454c983c50be655b3ef22025-01-31T02:45:10ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2021-059565Costs of community-wide mass drug administration and school-based deworming for soil-transmitted helminths: evidence from a randomised controlled trial in Benin, India and MalawiJudd Walson0ROBIN BAILEY1Katya Galactionova2Maitreyi Sahu3Samuel Paul Gideon4Saravanakumar Puthupalayam Kaliappan5Chloe Morozoff6Sitara Swarna Rao Ajjampur7Khumbo Kalua8Euripide Avokpaho9Moudachirou Ibikounle10Arianna Rubin Means11James Simwanza12Wongani Lungu13Parfait Houngbegnon14Adrian J F Luty15Rachel Pullan16Epidemiology, University of Washington, Seattle, Washington, USAClinical Research Department, London School of Hygiene & Tropical Medicine, London, UKDepartment of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, SwitzerlandFaculty of Medicine, University of Basel, Basel, SwitzerlandThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, IndiaThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, IndiaDepartment of Global Health, University of Washington, Seattle, Washington, USAThe Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, IndiaBlantyre Institute for Community Outreach, Blantyre, MalawiInstitut de Recherche Clinique du Bénin, Abomey-Calavi, BéninInstitut de Recherche Clinique du Bénin, Abomey-Calavi, BéninDepartment of Global Health, University of Washington, Seattle, Washington, USABlantyre Institute for Community Outreach, Blantyre, MalawiBlantyre Institute for Community Outreach, Blantyre, MalawiInstitut de Recherche Clinique du Bénin, Abomey-Calavi, BéninUniversité de Paris, MERIT, IRD, Paris, FranceDepartment of Disease Control, London School of Hygiene and Tropical Medicine, London, UKObjectives Current guidelines for the control of soil-transmitted helminths (STH) recommend deworming children and other high-risk groups, primarily using school-based deworming (SBD) programmes. However, targeting individuals of all ages through community-wide mass drug administration (cMDA) may interrupt STH transmission in some settings. We compared the costs of cMDA to SBD to inform decision-making about future updates to STH policy.Design We conducted activity-based microcosting of cMDA and SBD for 2 years in Benin, India and Malawi within an ongoing cMDA trial.Setting Field sites and collaborating research institutions.Primary and secondary outcomes We calculated total financial and opportunity costs and costs per treatment administered (unit costs in 2019 USD ($)) from the service provider perspective, including costs related to community drug distributors and other volunteers.Results On average, cMDA unit costs were more expensive than SBD in India ($1.17 vs $0.72) and Malawi ($2.26 vs $1.69), and comparable in Benin ($2.45 vs $2.47). cMDA was more expensive than SBD in part because most costs (~60%) were ‘supportive costs’ needed to deliver treatment with high coverage, such as additional supervision and electronic data capture. A smaller fraction of cMDA costs (~30%) was routine expenditures (eg, drug distributor allowances). The remaining cMDA costs (~10%) were opportunity costs of staff and volunteer time. A larger percentage of SBD costs was opportunity costs for teachers and other government staff (between ~25% and 75%). Unit costs varied over time and were sensitive to the number of treatments administered.Conclusions cMDA was generally more expensive than SBD. Accounting for local staff time (volunteers, teachers, health workers) in community programmes is important and drives higher cost estimates than commonly recognised in the literature. Costs may be lower outside of a trial setting, given a reduction in supportive costs used to drive higher treatment coverage and economies of scale.Trial registration number NCT03014167.https://bmjopen.bmj.com/content/12/7/e059565.full |
| spellingShingle | Judd Walson ROBIN BAILEY Katya Galactionova Maitreyi Sahu Samuel Paul Gideon Saravanakumar Puthupalayam Kaliappan Chloe Morozoff Sitara Swarna Rao Ajjampur Khumbo Kalua Euripide Avokpaho Moudachirou Ibikounle Arianna Rubin Means James Simwanza Wongani Lungu Parfait Houngbegnon Adrian J F Luty Rachel Pullan Costs of community-wide mass drug administration and school-based deworming for soil-transmitted helminths: evidence from a randomised controlled trial in Benin, India and Malawi BMJ Open |
| title | Costs of community-wide mass drug administration and school-based deworming for soil-transmitted helminths: evidence from a randomised controlled trial in Benin, India and Malawi |
| title_full | Costs of community-wide mass drug administration and school-based deworming for soil-transmitted helminths: evidence from a randomised controlled trial in Benin, India and Malawi |
| title_fullStr | Costs of community-wide mass drug administration and school-based deworming for soil-transmitted helminths: evidence from a randomised controlled trial in Benin, India and Malawi |
| title_full_unstemmed | Costs of community-wide mass drug administration and school-based deworming for soil-transmitted helminths: evidence from a randomised controlled trial in Benin, India and Malawi |
| title_short | Costs of community-wide mass drug administration and school-based deworming for soil-transmitted helminths: evidence from a randomised controlled trial in Benin, India and Malawi |
| title_sort | costs of community wide mass drug administration and school based deworming for soil transmitted helminths evidence from a randomised controlled trial in benin india and malawi |
| url | https://bmjopen.bmj.com/content/12/7/e059565.full |
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