title: African Programme For Onchocerciasis Control 1995-2015: model-estimated health impact and cost.
abstract: BACKGROUND
  Onchocerciasis causes a considerable disease burden in Africa, mainly through skin and eye disease. Since 1995, the African Programme for Onchocerciasis Control (APOC) has coordinated annual mass treatment with ivermectin in 16 countries. In this study, we estimate the health impact of APOC and the associated costs from a program perspective up to 2010 and provide expected trends up to 2015.
  
  
  RESULTS
  With data on pre-control prevalence of infection and population coverage of mass treatment, we simulated trends in infection, blindness, visual impairment, and severe itch using the micro-simulation model ONCHOSIM, and estimated disability-adjusted life years (DALYs) lost due to onchocerciasis. We assessed financial costs for APOC, beneficiary governments, and non-governmental development organizations, excluding cost of donated drugs. We estimated that between 1995 and 2010, mass treatment with ivermectin averted 8.2 million DALYs due to onchocerciasis in APOC areas, at a nominal cost of about US$257 million. We expect that APOC will avert another 9.2 million DALYs between 2011 and 2015, at a nominal cost of US$221 million.
  
  
  CONCLUSIONS
  Our simulations suggest that APOC has had a remarkable impact on population health in Africa between 1995 and 2010. This health impact is predicted to double during the subsequent five years of the program, through to 2015. APOC is a highly cost-effective public health program. Given the anticipated elimination of onchocerciasis from some APOC areas, we expect even more health gains and a more favorable cost-effectiveness of mass treatment with ivermectin in the near future.
authors: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. l.coffeng@erasmusmc.nl
authors: Luc E
authors: LE
authors: Coffeng
authors: Wilma A
authors: WA
authors: Stolk
authors: Honorat G M
authors: HG
authors: Zouré
authors: J Lennert
authors: JL
authors: Veerman
authors: Koffi B
authors: KB
authors: Agblewonu
authors: Michele E
authors: ME
authors: Murdoch
authors: Mounkaila
authors: M
authors: Noma
authors: Grace
authors: G
authors: Fobi
authors: Jan Hendrik
authors: JH
authors: Richardus
authors: Donald A P
authors: DA
authors: Bundy
authors: Dik
authors: D
authors: Habbema
authors: Sake J
authors: SJ
authors: de Vlas
authors: Uche V
authors: UV
authors: Amazigo
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000191:economics* / Q000379:methods*; D003365:Costs and Cost Analysis; D005260:Female; D005369:Filaricides / Q000008:administration & dosage / Q000191:economics; D006801:Humans; D007559:Ivermectin / Q000008:administration & dosage / Q000191:economics; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009855:Onchocerciasis / Q000453:epidemiology* / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D005369:Filaricides; D007559:Ivermectin
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