Background:
Concerns that annual mass administration of ivermectin, the predominant strategy for onchocerciasis control/elimination, may not lead to elimination of parasite transmission (EoT) in all endemic areas, has increased interest in alternative treatment strategies. One such strategy is moxidectin. We performed an updated economic assessment of moxidectin- relative to ivermectin-based strategies.
Methods:
We investigated annual and biannual community-directed treatment with ivermectin (aCDTI, bCDTI) and moxidectin (aCDTM, bCDTM) implemented with minimal or enhanced coverage (65% or 80% of the total population taking the drug, respectively) in intervention-naïve areas with 30%, 50% or 70% microfilarial baseline prevalence (representative of hypo-, meso- and hyperendemic areas). We compared programmatic delivery costs for the number of treatments achieving 90% probability of EoT (EoT90), calculated with the individual-based stochastic transmission model EPIONCHO-IBM. We used the costs for 40 years of programme delivery when EoT90 was not reached earlier. Delivery costs do not include the drug costs.
Results:
aCDTM and bCDTM achieved EoT90 with lower programmatic delivery costs than aCDTI with one exception: aCDTM with minimal coverage did not achieve EoT90 in hyperendemic areas within 40 years. With minimal coverage, bCDTI delivery costs as much or more than aCDTM and bCDTM. With enhanced coverage, programmatic delivery costs for aCDTM and bCDTM were lower than for aCDTI and bCDTI.
Conclusions:
Moxidectin-based strategies could accelerate progress towards EoT and reduce programmatic delivery costs compared to ivermectin-based strategies. The costs of moxidectin to national programmes are needed to quantify whether delivery cost reductions will translate into overall programme cost reduction.