title: A population dynamic approach to evaluating the impact of school attendance on the unit cost and effectiveness of school-based schistosomiasis chemotherapy programmes.
abstract: This paper presents a first attempt at modelling the possible cost and effectiveness of reaching non-enrolled children through school-based programmes using empirical data from Egypt. A sex/school-attendance/age-structured population dynamic model was used to predict trends in infection and early disease. Four treatment delivery strategies were compared: school-based (coverage of 85 %) and school-aged targeted (coverage of 25, 50 and 85 %). The school-aged targeted strategies also included the school-based programme. For each alternative strategy, the maximum unit cost was calculated to obtain a cost-effectiveness ratio equal or smaller to the one obtained with the school-based programme (unit cost of US$ 0.60). The analysis showed that, for S. mansoni in Lower Egypt, a programme where only 85% of children attending school were treated would still prevent 77 % of the early disease cases prevented with a programme where 85 % of all school-age children were treated. However, using the school-aged targeted strategy, from US $ 0.06 to US $ 1.03 extra unit costs could be spent to reach non-enrolled children and still be more cost-effective. Treating non-enrolled children is an important consideration in maximizing the effectiveness of treatment programmes while maintaining a cost-effectiveness comparable to school-based delivery.
authors.affiliation: The Wellcome Trust Centre for the Epidemiology of Infectious Disease, University of Oxford, UK. helene.carabin@ceid.ox.ac.uk
authors.forename: H
authors.initials: H
authors.lastname: Carabin
authors.forename: M S
authors.initials: MS
authors.lastname: Chan
authors.forename: H L
authors.initials: HL
authors.lastname: Guyatt
mesh_terms: D000293:Adolescent; D000818:Animals; D002648:Child; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006293:Health Promotion / Q000191:economics / Q000592:standards*; D006801:Humans; D008297:Male; D008954:Models, Biological; D011157:Population Dynamics; D012548:Schistosoma haematobium / Q000254:growth & development; D012550:Schistosoma mansoni / Q000254:growth & development; D012553:Schistosomiasis haematobia / Q000453:epidemiology / Q000517:prevention & control*; D012555:Schistosomiasis mansoni / Q000453:epidemiology / Q000517:prevention & control*; D012574:Schools / Q000706:statistics & numerical data