Health, financial, and education gains of investing in preventive chemotherapy for schistosomiasis, soil-transmitted helminthiases, and lymphatic filariasis in Madagascar: A modeling study

Background: Neglected tropical diseases (NTDs) account for a large disease burden in sub-Saharan Africa. While the general cost-effectiveness of NTD interventions to improve health outcomes has been assessed, few studies have also accounted for the financial and education gains of investing in NTD control. Methods: We built on extended cost-effectiveness analysis (ECEA) methods to assess the health gains (e.g. infections, disability-adjusted life years or DALYs averted), household financial gains (out-of-pocket expenditures averted), and education gains (cases of school absenteeism averted) for five NTD interventions that the government of Madagascar aims to roll out nationally. The five NTDs considered were schistosomiasis, lymphatic filariasis, and three soil-transmitted helminthiases (Ascaris lumbricoides, Trichuris trichiura, and hookworm infections). Results: The estimated incremental cost-effectiveness for the roll-out of preventive chemotherapy for all NTDs jointly was USD125 per DALY averted (95% uncertainty range: 65–231), and its benefit-cost ratio could vary between 5 and 31. Our analysis estimated that, per dollar spent, schistosomiasis preventive chemotherapy, in particular, could avert a large number of infections (176,000 infections averted per $100,000 spent), DALYs (2,000 averted per $100,000 spent), and cases of school absenteeism (27,000 school years gained per $100,000 spent). Conclusion: This analysis incorporates financial and education gains into the economic evaluation of health interventions, and therefore provides information about the efficiency of attainment of three Sustainable Development Goals (SDGs). Our findings reveal how the national scale-up of NTD control in Madagascar can help address health (SDG3), economic (SDG1), and education (SDG4) goals. This study further highlights the potentially large societal benefits of investing in NTD control in low-resource settings. Author summary: Neglected tropical diseases (NTDs) cause ill health and disability among the poorest people with extensive economic and social effects. Existing cost-effectiveness analyses, however, have typically focused on the health gains associated with the scale up of preventive chemotherapy. This misses the key fact that health investments can contribute to gains in other sectors leading to broader benefits of NTD control. This study determines the value for money of national NTD control across multiple sectors. We assess the potential health, financial, and education gains of NTD control in a setting where NTDs are highly endemic. We build on extended cost-effectiveness analysis methods to examine five interventions which governments aim to scale up nationally. We find that, per dollar spent, preventive chemotherapy could avert a substantial number of infections, disability-adjusted life years or DALYs, and cases of school absenteeism. Our analysis incorporates broader wealth and education gains into the economic evaluation of health interventions and therefore provides information about the efficiency of attainment of three Sustainable Development Goals. This study highlights the potentially large societal benefits of investing in NTD control.