title: The potential impact of moxidectin on onchocerciasis elimination in Africa: an economic evaluation based on the Phase II clinical trial data.
abstract: BACKGROUND
  Spurred by success in several foci, onchocerciasis control policy in Africa has shifted from morbidity control to elimination of infection. Clinical trials have demonstrated that moxidectin is substantially more efficacious than ivermectin in effecting sustained reductions in skin microfilarial load and, therefore, may accelerate progress towards elimination. We compare the potential cost-effectiveness of annual moxidectin with annual and biannual ivermectin treatment.
  
  
  METHODS
  Data from the first clinical study of moxidectin were used to parameterise the onchocerciasis transmission model EPIONCHO to investigate, for different epidemiological and programmatic scenarios in African savannah settings, the number of years and in-country costs necessary to reach the operational thresholds for cessation of treatment, comparing annual and biannual ivermectin with annual moxidectin treatment.
  
  
  RESULTS
  Annual moxidectin and biannual ivermectin treatment would achieve similar reductions in programme duration relative to annual ivermectin treatment. Unlike biannual ivermectin treatment, annual moxidectin treatment would not incur a considerable increase in programmatic costs and, therefore, would generate sizeable in-country cost savings (assuming the drug is donated). Furthermore, the impact of moxidectin, unlike ivermectin, was not substantively influenced by the timing of treatment relative to seasonal patterns of transmission.
  
  
  CONCLUSIONS
  Moxidectin is a promising new drug for the control and elimination of onchocerciasis. It has high programmatic value particularly when resource limitation prevents a biannual treatment strategy, or optimal timing of treatment relative to peak transmission season is not feasible.
authors.affiliation: London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, St. Mary's Campus, Norfolk Place, London, W2 1PG, UK. hugo.turner06@imperial.ac.uk.|Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK. hugo.turner06@imperial.ac.uk.
authors.forename: Hugo C
authors.initials: HC
authors.lastname: Turner
authors.affiliation: London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, St. Mary's Campus, Norfolk Place, London, W2 1PG, UK. m.walker06@imperial.ac.uk.|Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK. m.walker06@imperial.ac.uk.
authors.forename: Martin
authors.initials: M
authors.lastname: Walker
authors.affiliation: Onchocerciasis Chemotherapy Research Centre, Hohoe, Ghana. skwakuattah@yahoo.com.|Department of Microbiology, University of Ghana Medical School, Accra, Ghana. skwakuattah@yahoo.com.
authors.forename: Simon K
authors.initials: SK
authors.lastname: Attah
authors.affiliation: Onchocerciasis Chemotherapy Research Centre, Hohoe, Ghana. opokuopn@hotmail.com.
authors.forename: Nicholas O
authors.initials: NO
authors.lastname: Opoku
authors.affiliation: Onchocerciasis Chemotherapy Research Centre, Hohoe, Ghana. hugo.turner06@imperial.ac.uk.
authors.forename: Kwablah
authors.initials: K
authors.lastname: Awadzi
authors.affiliation: UNICEF/UNDP/World Bank/ WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland. kuesela@who.int.
authors.forename: Annette C
authors.initials: AC
authors.lastname: Kuesel
authors.affiliation: London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, St. Mary's Campus, Norfolk Place, London, W2 1PG, UK. m.basanez@imperial.ac.uk.|Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK. m.basanez@imperial.ac.uk.
authors.forename: María-Gloria
authors.initials: MG
authors.lastname: Basáñez
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D000871:Anthelmintics / Q000191:economics / Q000627:therapeutic use; D017322:Clinical Trials, Phase II as Topic; D017048:Health Care Costs; D006801:Humans; D007559:Ivermectin / Q000191:economics / Q000627:therapeutic use; D018942:Macrolides / Q000191:economics* / Q000627:therapeutic use*; D008954:Models, Biological; D018803:Models, Economic; D009855:Onchocerciasis / Q000188:drug therapy* / Q000191:economics / Q000517:prevention & control; D010349:Patient Compliance; D011159:Population Surveillance
chemical_list: D000871:Anthelmintics; D018942:Macrolides; D007559:Ivermectin; C027837:moxidectin