title: Benchmarking the Cost per Person of Mass Treatment for Selected Neglected Tropical Diseases: An Approach Based on Literature Review and Meta-regression with Web-Based Software Application.
abstract: Advocacy around mass treatment for the elimination of selected Neglected Tropical Diseases (NTDs) has typically put the cost per person treated at less than US$ 0.50. Whilst useful for advocacy, the focus on a single number misrepresents the complexity of delivering "free" donated medicines to about a billion people across the world. We perform a literature review and meta-regression of the cost per person per round of mass treatment against NTDs. We develop a web-based software application (https://healthy.shinyapps.io/benchmark/) to calculate setting-specific unit costs against which programme budgets and expenditures or results-based pay-outs can be benchmarked.
  
  
  
  We reviewed costing studies of mass treatment for the control, elimination or eradication of lymphatic filariasis, schistosomiasis, soil-transmitted helminthiasis, onchocerciasis, trachoma and yaws. These are the main 6 NTDs for which mass treatment is recommended. We extracted financial and economic unit costs, adjusted to a standard definition and base year. We regressed unit costs on the number of people treated and other explanatory variables. Regression results were used to "predict" country-specific unit cost benchmarks.
  
  
  
  We reviewed 56 costing studies and included in the meta-regression 34 studies from 23 countries and 91 sites. Unit costs were found to be very sensitive to economies of scale, and the decision of whether or not to use local volunteers. Financial unit costs are expected to be less than 2015 US$ 0.50 in most countries for programmes that treat 100 thousand people or more. However, for smaller programmes, including those in the "last mile", or those that cannot rely on local volunteers, both economic and financial unit costs are expected to be higher.
  
  
  
  The available evidence confirms that mass treatment offers a low cost public health intervention on the path towards universal health coverage. However, more costing studies focussed on elimination are needed. Unit cost benchmarks can help in monitoring value for money in programme plans, budgets and accounts, or in setting a reasonable pay-out for results-based financing mechanisms.
authors.affiliation: Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Christopher
authors.initials: C
authors.lastname: Fitzpatrick
authors.affiliation: Imperial College London, London, United Kingdom.
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Fleming
authors.affiliation: Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.|University of York, York, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Madin-Warburton
authors.affiliation: Universität Düsseldorf, Düsseldorf, Germany.
authors.forename: Timm
authors.initials: T
authors.lastname: Schneider
authors.affiliation: Health Economics Unit, University of Cape Town, Cape Town, South Africa.
authors.forename: Filip
authors.initials: F
authors.lastname: Meheus
authors.affiliation: Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Kingsley
authors.initials: K
authors.lastname: Asiedu
authors.affiliation: Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Solomon
authors.affiliation: Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Antonio
authors.initials: A
authors.lastname: Montresor
authors.affiliation: Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland.
authors.forename: Gautam
authors.initials: G
authors.lastname: Biswas
mesh_terms: D000871:Anthelmintics / Q000191:economics / Q000627:therapeutic use; D019985:Benchmarking; D004605:Elephantiasis, Filarial / Q000188:drug therapy / Q000191:economics; D017048:Health Care Costs; D005102:Health Expenditures; D006373:Helminthiasis / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D020407:Internet; D058069:Neglected Diseases / Q000188:drug therapy* / Q000191:economics*; D009855:Onchocerciasis / Q000188:drug therapy / Q000191:economics; D011634:Public Health; D015980:Public Health Practice / Q000191:economics*; D012552:Schistosomiasis / Q000188:drug therapy / Q000191:economics; D012984:Software; D014329:Tropical Climate
chemical_list: D000871:Anthelmintics