title: Reaching the london declaration on neglected tropical diseases goals for onchocerciasis: an economic evaluation of increasing the frequency of ivermectin treatment in Africa.
abstract: BACKGROUND
  Recently, there has been a shift in onchocerciasis control policy, changing from prevention of morbidity toward elimination of infection. Switching from annual to biannual ivermectin distribution may accelerate progress toward the elimination goals. However, the settings where this strategy would be cost effective in Africa have not been described.
  
  
  METHODS
  An onchocerciasis transmission framework (EpiOncho) was coupled to a disease model in order to explore the impact on disability-adjusted life years averted, program cost, and program duration of biannual ivermectin treatment in different epidemiological and programmatic scenarios in African savannah.
  
  
  RESULTS
  While biannual treatment yields only small additional health gains, its benefit is pronounced in the context of the elimination goals, shortening the time frames for and increasing the feasibility of reaching the proposed operational thresholds for stopping treatment. In settings with high precontrol endemicity (and/or poor coverage and compliance), it may not be possible to reach such thresholds even within 50 years of annual ivermectin, requiring adoption of biannual treatment. Our projections highlight the crucial role played by coverage and compliance in achieving the elimination goals.
  
  
  CONCLUSIONS
  Biannual ivermectin treatment improves the chances of reaching the 2020/2025 elimination goals, potentially generating programmatic cost savings in settings with high precontrol endemicity. However, its benefit and cost are highly sensitive to levels of systematic noncompliance and, in many settings, it will lead to an increase in costs. Furthermore, it may not always be feasible to implement biannual treatment, particularly in hard-to-reach populations. This highlights the continued need for a macrofilaricide.
authors.affiliation: Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London, United Kingdom.
authors.forename: Hugo C
authors.initials: HC
authors.lastname: Turner
authors.affiliation: Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Walker
authors.affiliation: Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London, United Kingdom.
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Churcher
authors.affiliation: Council for Scientific and Industrial Research, Water Research Institute.
authors.forename: Mike Y
authors.initials: MY
authors.lastname: Osei-Atweneboana
authors.affiliation: Neglected Tropical Diseases Control Programme, Disease Control and Prevention Department, Ghana Health Service, Accra, Ghana.
authors.forename: Nana-Kwadwo
authors.initials: NK
authors.lastname: Biritwum
authors.affiliation: Mectizan Donation Program, Decatur, Georgia.
authors.forename: Adrian
authors.initials: A
authors.lastname: Hopkins
authors.affiliation: Institute of Parasitology, Centre for Host-Parasite Interactions, McGill University (Macdonald Campus), Sainte Anne-de-Bellevue, Quebec, Canada.
authors.forename: Roger K
authors.initials: RK
authors.lastname: Prichard
authors.affiliation: Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine (St. Mary's Campus), Imperial College London, United Kingdom.
authors.forename: María-Gloria
authors.initials: MG
authors.lastname: Basáñez
mesh_terms: D000349:Africa / Q000453:epidemiology; D000871:Anthelmintics / Q000191:economics* / Q000627:therapeutic use*; D060740:Disease Eradication; D017048:Health Care Costs; D006801:Humans; D007559:Ivermectin / Q000191:economics* / Q000627:therapeutic use*; D058069:Neglected Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D009855:Onchocerciasis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control*
chemical_list: D000871:Anthelmintics; D007559:Ivermectin
keywords: cost effectiveness; economic evaluation; ivermectin; onchocerciasis; treatment frequency