National mass drug administration costs for lymphatic filariasis elimination.
BACKGROUND
Because lymphatic filariasis (LF) elimination efforts are hampered by a dearth of economic information about the cost of mass drug administration (MDA) programs (using either albendazole with diethylcarbamazine [DEC] or albendazole with ivermectin), a multicenter study was undertaken to determine the costs of MDA programs to interrupt transmission of infection with LF. Such results are particularly important because LF programs have the necessary diagnostic and treatment tools to eliminate the disease as a public health problem globally, and already by 2006, the Global Programme to Eliminate LF had initiated treatment programs covering over 400 million of the 1.3 billion people at risk.


RESULTS
To obtain annual costs to carry out the MDA strategy, researchers from seven countries developed and followed a common cost analysis protocol designed to estimate 1) the total annual cost of the LF program, 2) the average cost per person treated, and 3) the relative contributions of the endemic countries and the external partners. Costs per person treated ranged from $0.06 to $2.23. Principal reasons for the variation were 1) the age (newness) of the MDA program, 2) the use of volunteers, and 3) the size of the population treated. Substantial contributions by governments were documented - generally 60%-90% of program operation costs, excluding costs of donated medications.


CONCLUSIONS
MDA for LF elimination is comparatively inexpensive in relation to most other public health programs. Governments and communities make the predominant financial contributions to actual MDA implementation, not counting the cost of the drugs themselves. The results highlight the impact of the use of volunteers on program costs and provide specific cost data for 7 different countries that can be used as a basis both for modifying current programs and for developing new ones.
Goldman
Ann S
AS
Department of Epidemiology, The George Washington School of Public Health and Health Services, Washington, DC, United States of America. sphasg@gwumc.edu
Guisinger
Victoria H
VH
Aikins
Moses
M
Amarillo
Maria Lourdes E
ML
Belizario
Vicente Y
VY
Garshong
Bertha
B
Gyapong
John
J
Kabali
Conrad
C
Kamal
Hussein A
HA
Kanjilal
Sanjat
S
Kyelem
Dominique
D
Lizardo
Jefrey
J
Malecela
Mwele
M
Mubyazi
Godfrey
G
Nitièma
P Abdoulaye
PA
Ramzy
Reda M R
RM
Streit
Thomas G
TG
Wallace
Aaron
A
Brady
Molly A
MA
Rheingans
Richard
R
Ottesen
Eric A
EA
Haddix
Anne C
AC
D015766:Albendazole / Q000191:economics / Q000627:therapeutic use; D000871:Anthelmintics / Q000191:economics / Q000627:therapeutic use*; D002050:Burkina Faso / Q000453:epidemiology; D003365:Costs and Cost Analysis; D004049:Diethylcarbamazine / Q000191:economics / Q000627:therapeutic use; D004293:Dominican Republic / Q000453:epidemiology; D004358:Drug Therapy / Q000191:economics / Q000379:methods; D004534:Egypt / Q000453:epidemiology; D004604:Elephantiasis / Q000188:drug therapy / Q000517:prevention & control; D004605:Elephantiasis, Filarial / Q000188:drug therapy* / Q000517:prevention & control; D005869:Ghana / Q000453:epidemiology; D006205:Haiti / Q000453:epidemiology; D006801:Humans; D010348:Patient Care Team; D010679:Philippines / Q000453:epidemiology; D013636:Tanzania / Q000453:epidemiology
D000871:Anthelmintics; D015766:Albendazole; D004049:Diethylcarbamazine