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  • Title: Controlling schistosomiasis: the cost-effectiveness of alternative delivery strategies.
    Author: Guyatt H, Evans D, Lengeler C, Tanner M.
    Journal: Health Policy Plan; 1994 Dec; 9(4):385-95. PubMed ID: 10139471.
    Abstract:
    Sustainable schistosomiasis control cannot be based on large-scale vertical treatment strategies in most endemic countries, yet little is known about the costs and effectiveness of more affordable options. This paper presents calculations of the cost-effectiveness of two forms of chemotherapy targeted at school-children and compares them with chemotherapy integrated into the routine activities of the primary health care system. The focus is on Schistosoma haematobium. Economic and epidemiological data are taken from the Kilombero District of Tanzania. The paper also develops a framework for possible use by programme managers to evaluate similar options in different epidemiological settings. The results suggest that all three options are more affordable and sustainable than the vertical strategies for which cost data are available in the literature. Passive testing and treatment through primary health facilities proved the most effective and cost-effective option given the screening and compliance rates observed in the Kilombero District. In rural Kilombero District in the Morogoro Region of southeast Tanzania, where urinary schistosomiasis is endemic in most villages, a cost-effectiveness study was conducted to compare the costs and coverage of 2 forms of delivering chemotherapy to school children and then compared these options with chemotherapy integrated into the routine activities of the primary health care (PHC) system and targeted at anyone using the PHC facilities. The student-centered alternatives to control schistosomiasis included a mobile team treating all children at all 77 primary schools in the district with a single oral dose of praziquantel (40 mg/kg) (MMT = mass treatment by mobile team) and school teachers annually screening children using Sangur reagent strips and referring all positives to the nearest dispensary for treatment (RST = reagent strip testing). One teacher per school attended a workshop for training in reagent strip testing, health education, and materials needed for screening their school. The third option was passive case detecting using urine sedimentation and subsequent treatment of positives with a single oral dose of praziquantel (40 mg/kg) at the dispensary (PTT = passive testing and treatment). The indicator of effectiveness was number of infected persons treated (adults + children). The PTT option covered the most people. The analysis showed that the most cost effective option was indeed PTT (financial and economic costs per infected person treated were US$ 1.78 and 1.87, respectively; they were US$ 3.71 and 3.82 for RST and US$ 4.48 and 4.50 for MMT). It remained the most cost effective option, even when the analysis considered only the number of children treated. All 3 options were more affordable and sustainable than vertical strategies examined in the literature. This report provides program managers with a framework to evaluate similar strategies in various epidemiological settings.
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