Final published version, 666 KB, fulltext
Available under license: CC BY: Creative Commons Attribution 4.0 International License
Final published version, 441 KB, fulltext
Available under license: CC BY: Creative Commons Attribution 4.0 International License
Final published version
Licence: CC BY: Creative Commons Attribution 4.0 International License
Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
}
TY - JOUR
T1 - Improving the Cost-efficiency of Preventive Chemotherapy
T2 - Impact of New Diagnostics on Stopping Decisions for Control of Schistosomiasis
AU - Coffeng, Luc E
AU - Graham, Matthew
AU - Browning, Raiha
AU - Kura, Klodeta
AU - Diggle, Peter J
AU - Denwood, Matthew
AU - Medley, Graham F
AU - Anderson, Roy M
AU - de Vlas, Sake J
PY - 2024/5/15
Y1 - 2024/5/15
N2 - BackgroundControl of schistosomiasis (SCH) relies on the regular distribution of preventive chemotherapy (PC) over many years. For the sake of sustainable SCH control, a decision must be made at some stage to scale down or stop PC. These "stopping decisions" are based on population surveys that assess whether infection levels are sufficiently low. However, the limited sensitivity of the currently used diagnostic (Kato-Katz [KK]) to detect low-intensity infections is a concern. Therefore, the use of new, more sensitive, molecular diagnostics has been proposed.MethodsThrough statistical analysis of Schistosoma mansoni egg counts collected from Burundi and a simulation study using an established transmission model for schistosomiasis, we investigated the extent to which more sensitive diagnostics can improve decision making regarding stopping or continuing PC for the control of S. mansoni.ResultsWe found that KK-based strategies perform reasonably well for determining when to stop PC at a local scale. Use of more sensitive diagnostics leads to a marginally improved health impact (person-years lived with heavy infection) and comes at a cost of continuing PC for longer (up to around 3 years), unless the decision threshold for stopping PC is adapted upward. However, if this threshold is set too high, PC may be stopped prematurely, resulting in a rebound of infection levels and disease burden (+45% person-years of heavy infection).ConclusionsWe conclude that the potential value of more sensitive diagnostics lies more in the reduction of survey-related costs than in the direct health impact of improved parasite control.
AB - BackgroundControl of schistosomiasis (SCH) relies on the regular distribution of preventive chemotherapy (PC) over many years. For the sake of sustainable SCH control, a decision must be made at some stage to scale down or stop PC. These "stopping decisions" are based on population surveys that assess whether infection levels are sufficiently low. However, the limited sensitivity of the currently used diagnostic (Kato-Katz [KK]) to detect low-intensity infections is a concern. Therefore, the use of new, more sensitive, molecular diagnostics has been proposed.MethodsThrough statistical analysis of Schistosoma mansoni egg counts collected from Burundi and a simulation study using an established transmission model for schistosomiasis, we investigated the extent to which more sensitive diagnostics can improve decision making regarding stopping or continuing PC for the control of S. mansoni.ResultsWe found that KK-based strategies perform reasonably well for determining when to stop PC at a local scale. Use of more sensitive diagnostics leads to a marginally improved health impact (person-years lived with heavy infection) and comes at a cost of continuing PC for longer (up to around 3 years), unless the decision threshold for stopping PC is adapted upward. However, if this threshold is set too high, PC may be stopped prematurely, resulting in a rebound of infection levels and disease burden (+45% person-years of heavy infection).ConclusionsWe conclude that the potential value of more sensitive diagnostics lies more in the reduction of survey-related costs than in the direct health impact of improved parasite control.
KW - Bilharzia
KW - Diagnostic Performance
KW - Cost-efficiency
KW - Fecal Smear
KW - Decision Criterion
KW - Animals
KW - Humans
KW - Schistosoma mansoni
KW - Schistosomiasis
KW - Schistosomiasis mansoni
KW - Anthelmintics
KW - Parasite Egg Count
KW - Chemoprevention
KW - Sensitivity and Specificity
KW - Adolescent
KW - Adult
KW - Child
KW - Cost-Benefit Analysis
KW - Female
KW - Male
KW - Young Adult
U2 - 10.1093/cid/ciae020
DO - 10.1093/cid/ciae020
M3 - Journal article
VL - 78
SP - S153-S159
JO - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
SN - 1058-4838
IS - Suppl. 2
ER -