title: Financial and Economic Costs of the Elimination and Eradication of Onchocerciasis (River Blindness) in Africa.
abstract: BACKGROUND
  Onchocerciasis (river blindness) is a parasitic disease transmitted by blackflies. Symptoms include severe itching, skin lesions, and vision impairment including blindness. More than 99% of all cases are concentrated in sub-Saharan Africa. Fortunately, vector control and community-directed treatment with ivermectin have significantly decreased morbidity, and the treatment goal is shifting from control to elimination in Africa.
  
  
  METHODS
  We estimated financial resources and societal opportunity costs associated with scaling up community-directed treatment with ivermectin and implementing surveillance and response systems in endemic African regions for alternative treatment goals--control, elimination, and eradication. We used a micro-costing approach that allows adjustment for time-variant resource utilization and for the heterogeneity in the demographic, epidemiological, and political situation.
  
  
  RESULTS
  The elimination and eradication scenarios, which include scaling up treatments to hypo-endemic and operationally challenging areas at the latest by 2021 and implementing intensive surveillance, would allow savings of $1.5 billion and $1.6 billion over 2013-2045 as compared to the control scenario. Although the elimination and eradication scenarios would require higher surveillance costs ($215 million and $242 million) than the control scenario ($47 million), intensive surveillance would enable treatments to be safely stopped earlier, thereby saving unnecessary costs for prolonged treatments as in the control scenario lacking such surveillance and response systems.
  
  
  CONCLUSIONS
  The elimination and eradication of onchocerciasis are predicted to allow substantial cost-savings in the long run. To realize cost-savings, policymakers should keep empowering community volunteers, and pharmaceutical companies would need to continue drug donation. To sustain high surveillance costs required for elimination and eradication, endemic countries would need to enhance their domestic funding capacity. Societal and political will would be critical to sustaining all of these efforts in the long term.
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Kim
authors.affiliation: ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
authors.forename: Elisa
authors.initials: E
authors.lastname: Sicuri
authors.affiliation: Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Tediosi
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D000818:Animals; D003140:Communicable Disease Control / Q000191:economics* / Q000379:methods*; D060740:Disease Eradication / Q000191:economics* / Q000379:methods*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D062665:Epidemiological Monitoring; D005369:Filaricides / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs; D006801:Humans; D007300:Insect Control / Q000191:economics / Q000379:methods; D007303:Insect Vectors; D007559:Ivermectin / Q000191:economics / Q000627:therapeutic use; D009855:Onchocerciasis / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control*; D012843:Simuliidae / Q000254:growth & development / Q000469:parasitology
chemical_list: D005369:Filaricides; D007559:Ivermectin