Cost-effectiveness of trachoma control in seven world regions.
OBJECTIVE
The fight against blinding trachoma is being addressed with an integrated strategy of surgery, antibiotics, hygiene promotion, and environmental improvement-the SAFE strategy, but its cost-effectiveness is largely unknown. This paper estimates the cost effectiveness of surgery and antibiotics in trachoma-endemic areas in seven world regions.


METHODS
A population model was applied to follow the lifelong impact on individuals receiving trachoma control. Intervention costs and effectiveness estimates were based on a combination of primary data collection and literature review.


RESULTS
Providing trichiasis surgery to 80% of those who need it would avert over 11 million DALYs per year globally, with cost effectiveness ranging from I$13 to I$78 per DALY averted across regions. Mass antibiotic treatment of all children using azythromycin at prevailing market prices would avert more than 4 million DALYs per year globally with cost-effectiveness ranging between I$9,000 and I$65,000 per DALY averted. The intervention is only cost-effective if azythromycin is donated or becomes available at reduced prices. Mass treatment of all children with tetracycline and targeted treatment with azythromycin are not cost-effective.


CONCLUSIONS
As individual components of the SAFE strategy, trichiasis surgery for trachoma is a cost-effective way of restoring sight in all epidemiological sub-regions considered, as is the use of azythromycin, if donated or at reduced prices. Large study uncertainties do not change study conclusions. The results should be interpreted in the context of the overall SAFE strategy to address issues of sustainability.
Baltussen
Rob M P M
RM
Institute for Medical Technology Assessment, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands.
Sylla
Mariame
M
Frick
Kevin D
KD
Mariotti
Silvio P
SP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D017963:Azithromycin / Q000191:economics / Q000627:therapeutic use; D001766:Blindness / Q000191:economics / Q000517:prevention & control; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D005141:Eyelid Diseases / Q000191:economics / Q000517:prevention & control; D005260:Female; D005843:Geography; D014943:Global Health; D006201:Hair Diseases / Q000191:economics / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000191:economics*; D013752:Tetracycline / Q000191:economics / Q000627:therapeutic use; D014141:Trachoma / Q000191:economics* / Q000517:prevention & control*
D000900:Anti-Bacterial Agents; D017963:Azithromycin; D013752:Tetracycline