title: Disease control priorities for neglected tropical diseases: lessons from priority ranking based on the quality of evidence, cost effectiveness, severity of disease, catastrophic health expenditures, and loss of productivity.
abstract: BACKGROUND
  In the context of limited health care budgets in countries where Neglected Tropical Diseases (NTDs) are endemic, scaling up disease control interventions entails the setting of priorities. However, solutions based solely on cost-effectiveness analyses may lead to biased and insufficiently justified priorities.
  
  
  OBJECTIVE
  The objectives of this paper are to 1) demonstrate how a range of equity concerns can be used to identify feasible priority setting criteria, 2) show how these criteria can be fed into a multi-criteria decision-making matrix, and 3) discuss the conditions under which this decision-making procedure should be carried out in a real-world decision-making context.
  
  
  METHODS
  This paper draws on elements from theories of decision analysis and ethical theories of fair resource allocation. We explore six typical NTD interventions by employing a modified multi-criteria decision analysis model with predefined criteria, drawn from a priority setting guide under development by the WHO. To identify relevant evidence for the six chosen interventions, we searched the PubMed and Cochrane databases.
  
  
  CONCLUSIONS
  Our in vitro multi-criteria decision analysis suggested that case management for visceral leishmaniasis should be given a higher priority than mass campaigns to prevent soil-transmitted helminthic infections. This seems to contradict current health care priorities and recommendations in the literature. We also consider procedural conditions that should be met in a contextualised decision-making process and we stress the limitations of this study exercise.
  
  
  CONCLUSIONS
  By exploring how several criteria relevant to the multi-facetted characteristics of NTDs can be taken into account simultaneously, we are able to suggest how improved priority settings among NTDs can be realised.
authors.forename: Elisabeth Marie
authors.initials: EM
authors.lastname: Strømme
authors.forename: Kristine
authors.initials: K
authors.lastname: Baerøe
authors.forename: Ole Frithjof
authors.initials: OF
authors.lastname: Norheim
mesh_terms: D003362:Cost-Benefit Analysis; D003715:Dengue / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D006233:Persons with Disabilities; D004526:Efficiency; D017598:Efficiency, Organizational; D004605:Elephantiasis, Filarial / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D019317:Evidence-Based Medicine; D005102:Health Expenditures; D006292:Health Priorities; D006373:Helminthiasis / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D058069:Neglected Diseases / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D009855:Onchocerciasis / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D014141:Trachoma / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D014329:Tropical Climate; D014330:Tropical Medicine
keywords: Cost Effectiveness; Decision Making; Evidence Based Practice; Health Priorities; Neglected Diseases