Persons treated in the NTD programme¹.

1<p>Total persons treated according to NTD Control Programme treatment registers and Village Household Register Books (using available data sources). Of the eight villages in which the study was conducted, only the above three villages had a treatment register that appeared complete enough to use for analysis.</p>*<p>Persons eligible for treatment include persons ages five and older who are not seriously ill (for praziquantel), persons ages five and older who are not seriously ill, pregnant or breastfeeding (for ivermectin and zithromax), or persons ages 1 and older who are not seriously ill, including pregnant women in their second or third trimester (for albendazole).</p>†<p>Treatment registers are kept by the CMDs in each community and are used to register participants who are eligible to participate in the NTD programme.</p>††<p>VHRB is Village Household Register Book which is kept by the Chairman of the Local Council (the Village Level government structure) in each village, and registers the number of persons living in each village (including births, deaths, new migrants, etc.) including age and gender.</p

Total number of focus groups and study participants, Buyende and Kamuli districts, Uganda 2011.

1<p><i>Includes members of the Local Council 1 and Religious Leaders.</i></p

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

<div><p>Background</p><p>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$0.50. Whilst useful for advocacy, the focus on a single number misrepresents the complexity of delivering “free” donated medicines to about a billion people across the world. We perform a literature review and meta-regression of the cost per person per round of mass treatment against NTDs. We develop a web-based software application (<a href="https://healthy.shinyapps.io/benchmark/" target="_blank">https://healthy.shinyapps.io/benchmark/</a>) to calculate setting-specific unit costs against which programme budgets and expenditures or results-based pay-outs can be benchmarked.</p><p>Methods</p><p>We reviewed costing studies of mass treatment for the control, elimination or eradication of lymphatic filariasis, schistosomiasis, soil-transmitted helminthiasis, onchocerciasis, trachoma and yaws. These are the main 6 NTDs for which mass treatment is recommended. We extracted financial and economic unit costs, adjusted to a standard definition and base year. We regressed unit costs on the number of people treated and other explanatory variables. Regression results were used to “predict” country-specific unit cost benchmarks.</p><p>Results</p><p>We reviewed 56 costing studies and included in the meta-regression 34 studies from 23 countries and 91 sites. Unit costs were found to be very sensitive to economies of scale, and the decision of whether or not to use local volunteers. Financial unit costs are expected to be less than 2015 US$ 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.</p><p>Discussion</p><p>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.</p></div

Economic unit costs (excluding volunteer time) and population treated, by study (across years, sites and comparators).

<p>Dots represent individual study results, and lines represent the least squares line of best fit for studies with more than two results. The horizontal line at US$ 0.50 marks the oft-cited unit cost typically used in advocacy.</p

Availability of costing studies among low- and middle-income countries, by disease.

<p>Most recent year refers to the most recent year of study, not the most recent year of publication.</p

Financial unit cost benchmarks in low- and middle-income countries at different scales of implementation, using volunteers but excluding the (economic) cost of volunteer time.

<p>The legend excludes Vanuatu. See <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0005037#pntd.0005037.s006" target="_blank">S5 Table</a> in the Supplemental Information for results for Vanuatu.</p

Financial unit cost and population treated, by study (across years, sites and comparators).

<p>Dots represent individual study results, and lines represent the least squares line of best fit for studies with more than two results. The horizontal line at US$ 0.50 marks the oft-cited unit cost typically used in advocacy.</p

Classification of financial and economic unit costs (excluding medicines¹)

<p>Classification of financial and economic unit costs (excluding medicines<a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0005037#t001fn001" target="_blank">¹</a>)</p