Economic evaluation of gambiense human African trypanosomiasis elimination campaigns in five distinct transmission settings in the Democratic Republic of Congo

Antillon, M.; Huang, C.-I.; Crump, R. E.; Brown, P. E.; Snijders, R.; Miaka, E. M.; Keeling, M. J.; Rock, K. S.; Tediosi, F.

Background: Gambiense human African trypanosomiasis (gHAT) is marked for elimination of transmission (EOT) by 2030, but the disease persists in several low-income countries. We examine the cost-effectiveness of four gHAT elimination strategies in Democratic Republic of Congo (DRC), which has the highest burden of gHAT. Methods: We compared four strategies against gHAT by coupling a transmission model with a health outcomes model in five settings -- spanning low- to high-risk. Alongside passive surveillance (PS) in fixed health facilities, the strategies included active screening (AS) at average or high coverage levels, both alone or with vector control (VC). A scale-back algorithm was devised to simulate cessation of AS and VC when no cases were reported for three consecutive years. Outcomes were denominated in disability-adjusted life-years (DALYs) and costs until 2040 were denominated in 2018 US$. Results: In high or moderate-risk settings, costs of gHAT strategies are primarily driven by AS and, if used, VC. Due to the cessation of AS and VC most investments (75-80%) will be made by 2030 and VC might be cost-saving while ensuring EOT. In low-risk settings, costs are driven by PS, and minimum-cost strategies consisting of AS and PS lead to EOT by 2030 with high probability. Conclusion: In many settings, the case for EOT by 2030 is a sensible use of resources, and investments in gHAT will decelerate within this decade in moderate- and low-risk regions.