title: Integrated surveys of neglected tropical diseases in southern Sudan: how much do they cost and can they be refined?
abstract: BACKGROUND
  Increasing emphasis on integrated control of neglected tropical diseases (NTDs) requires identification of co-endemic areas. Integrated surveys for lymphatic filariasis (LF), schistosomiasis and soil-transmitted helminth (STH) infection have been recommended for this purpose. Integrated survey designs inevitably involve balancing the costs of surveys against accuracy of classifying areas for treatment, so-called implementation units (IUs). This requires an understanding of the main cost drivers and of how operating procedures may affect both cost and accuracy of surveys. Here we report a detailed cost analysis of the first round of integrated NTD surveys in Southern Sudan.
  
  
  RESULTS
  Financial and economic costs were estimated from financial expenditure records and interviews with survey staff using an ingredients approach. The main outcome was cost per IU surveyed. Uncertain variables were subjected to univariate sensitivity analysis and the effects of modifying standard operating procedures were explored. The average economic cost per IU surveyed was USD 40,206 or USD 9,573, depending on the size of the IU. The major cost drivers were two key categories of recurrent costs: i) survey consumables, and ii) personnel.
  
  
  CONCLUSIONS
  The cost of integrated surveys in Southern Sudan could be reduced by surveying larger administrative areas for LF. If this approach was taken, the estimated economic cost of completing LF, schistosomiasis and STH mapping in Southern Sudan would amount to USD 1.6 million. The methodological detail and costing template provided here could be used to generate cost estimates in other settings and readily compare these to the present study, and may help budget for integrated and single NTDs surveys elsewhere.
authors.affiliation: Malaria Consortium-Africa Regional Office, Kampala, Uganda. j.kolaczinski@malariaconsortium.org
authors.forename: Jan H
authors.initials: JH
authors.lastname: Kolaczinski
authors.forename: Kara
authors.initials: K
authors.lastname: Hanson
authors.forename: Emily
authors.initials: E
authors.lastname: Robinson
authors.forename: Diana
authors.initials: D
authors.lastname: Picon
authors.forename: Anthony
authors.initials: A
authors.lastname: Sabasio
authors.forename: Martin
authors.initials: M
authors.lastname: Mpakateni
authors.forename: Mounir
authors.initials: M
authors.lastname: Lado
authors.forename: Stephen
authors.initials: S
authors.lastname: Moore
authors.forename: Nora
authors.initials: N
authors.lastname: Petty
authors.forename: Simon
authors.initials: S
authors.lastname: Brooker
mesh_terms: D017048:Health Care Costs; D006801:Humans; D010272:Parasitic Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D010274:Parasitology / Q000191:economics* / Q000379:methods*; D013397:Sudan / Q000453:epidemiology