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 US0.50.Whilstusefulforadvocacy,thefocusonasinglenumbermisrepresentsthecomplexityofdelivering“free”donatedmedicinestoaboutabillionpeopleacrosstheworld.Weperformaliteraturereviewandmeta−regressionofthecostperpersonperroundofmasstreatmentagainstNTDs.Wedevelopaweb−basedsoftwareapplication(<ahref="https://healthy.shinyapps.io/benchmark/"target="blank">https://healthy.shinyapps.io/benchmark/</a>)tocalculatesetting−specificunitcostsagainstwhichprogrammebudgetsandexpendituresorresults−basedpay−outscanbebenchmarked.</p><p>Methods</p><p>Wereviewedcostingstudiesofmasstreatmentforthecontrol,eliminationoreradicationoflymphaticfilariasis,schistosomiasis,soil−transmittedhelminthiasis,onchocerciasis,trachomaandyaws.Thesearethemain6NTDsforwhichmasstreatmentisrecommended.Weextractedfinancialandeconomicunitcosts,adjustedtoastandarddefinitionandbaseyear.Weregressedunitcostsonthenumberofpeopletreatedandotherexplanatoryvariables.Regressionresultswereusedto“predict”country−specificunitcostbenchmarks.</p><p>Results</p><p>Wereviewed56costingstudiesandincludedinthemeta−regression34studiesfrom23countriesand91sites.Unitcostswerefoundtobeverysensitivetoeconomiesofscale,andthedecisionofwhetherornottouselocalvolunteers.Financialunitcostsareexpectedtobelessthan2015US 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