title: A literature review of economic evaluations for a neglected tropical disease: human African trypanosomiasis ("sleeping sickness").
abstract: Human African trypanosomiasis (HAT) is a disease caused by infection with the parasite Trypanosoma brucei gambiense or T. b. rhodesiense. It is transmitted to humans via the tsetse fly. Approximately 70 million people worldwide were at risk of infection in 1995, and approximately 20,000 people across Africa are infected with HAT. The objective of this review was to identify existing economic evaluations in order to summarise cost-effective interventions to reduce, control, or eliminate the burden of HAT. The studies included in the review were compared and critically appraised in order to determine if there were existing standardised methods that could be used for economic evaluation of HAT interventions or if innovative methodological approaches are warranted. A search strategy was developed using keywords and was implemented in January 2014 in several databases. The search returned a total of 2,283 articles. After two levels of screening, a total of seven economic evaluations were included and underwent critical appraisal using the Scottish Intercollegiate Guidelines Network (SIGN) Methodology Checklist 6: Economic Evaluations. Results from the existing studies focused on the cost-effectiveness of interventions for the control and reduction of disease transmission. Modelling was a common method to forecast long-term results, and publications focused on interventions by category, such as case detection, diagnostics, drug treatments, and vector control. Most interventions were considered cost-effective based on the thresholds described; however, the current treatment, nifurtomix-eflornithine combination therapy (NECT), has not been evaluated for cost-effectiveness, and considerations for cost-effective strategies for elimination have yet to be completed. Overall, the current evidence highlights the main components that play a role in control; however, economic evaluations of HAT elimination strategies are needed to assist national decision makers, stakeholders, and key funders. These analyses would be of use, as HAT is currently being prioritized as a neglected tropical disease (NTD) to reach elimination by 2020.
authors: Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors: C Simone
authors: CS
authors: Sutherland
authors: Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.
authors: Joshua
authors: J
authors: Yukich
authors: Programs for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors: Ron
authors: R
authors: Goeree
authors: Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Centre for Research on Health and Social Care Management (CERGAS), Università Bocconi, Milano, Italy.
authors: Fabrizio
authors: F
authors: Tediosi
mesh_terms: D000349:Africa; D000818:Animals; D003362:Cost-Benefit Analysis; D000518:Eflornithine / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D007303:Insect Vectors / Q000469:parasitology; D008962:Models, Theoretical; D058069:Neglected Diseases / Q000191:economics / Q000517:prevention & control*; D014330:Tropical Medicine / Q000191:economics; D014344:Trypanocidal Agents / Q000191:economics / Q000627:therapeutic use*; D014347:Trypanosoma brucei gambiense / Q000472:pathogenicity; D014353:Trypanosomiasis, African / Q000191:economics* / Q000469:parasitology / Q000628:therapy*; D014370:Tsetse Flies / Q000469:parasitology
chemical_list: D014344:Trypanocidal Agents; D000518:Eflornithine
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