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Vaccination or mass drug administration against schistosomiasis: a hypothetical cost-effectiveness modelling comparison

Title: Vaccination or mass drug administration against schistosomiasis: a hypothetical cost-effectiveness modelling comparison
Authors: Collyer, BS
Turner, HC
Hollingsworth, TD
Keeling, MJ
Item Type: Journal Article
Abstract: Background Schistosomiasis is a neglected tropical disease, targeted by the World Health Organization for reduction in morbidity by 2020. It is caused by parasitic flukes that spread through contamination of local water sources. Traditional control focuses on mass drug administration, which kills the majority of adult worms, targeted at school-aged children. However, these drugs do not confer long-term protection and there are concerns over the emergence of drug resistance. The development of a vaccine against schistosomiasis opens the potential for control methods that could generate long-lasting population-level immunity if they are cost-effective. Methods Using an individual-based transmission model, matched to epidemiological data, we compared the cost-effectiveness of a range of vaccination programmes against mass drug administration, across three transmission settings. Health benefit was measured by calculating the heavy-intensity infection years averted by each intervention, while vaccine costs were assessed against robust estimates for the costs of mass drug administration obtained from data. We also calculated a critical vaccination cost, a cost beyond which vaccination might not be economically favorable, by benchmarking the cost-effectiveness of potential vaccines against the cost-effectiveness of mass drug administration, and examined the effect of different vaccine protection durations. Results We found that sufficiently low-priced vaccines can be more cost-effective than traditional drugs in high prevalence settings, and can lead to a greater reduction in morbidity over shorter time-scales. MDA or vaccination programmes that target the whole community generate the most health benefits, but are generally less cost-effective than those targeting children, due to lower prevalence of schistosomiasis in adults. Conclusions The ultimate cost-effectiveness of vaccination will be highly dependent on multiple vaccine characteristics, such as the efficacy, cost, safety and duration of protection, as well as the subset of population targeted for vaccination. However, our results indicate that if a vaccine could be developed with reasonable characteristics and for a sufficiently low cost, then vaccination programmes can be a highly cost-effective method of controlling schistosomiasis in high-transmission areas. The population-level immunity generated by vaccination will also inevitably improve the chances of interrupting transmission of the disease, which is the long-term epidemiological goal.
Issue Date: 23-Oct-2019
Date of Acceptance: 11-Oct-2019
URI: http://hdl.handle.net/10044/1/75620
DOI: 10.1186/s13071-019-3749-4
ISSN: 1756-3305
Publisher: BioMed Central
Start Page: 1
End Page: 14
Journal / Book Title: Parasites and Vectors
Volume: 12
Issue: 1
Copyright Statement: © The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Sponsor/Funder: Bill & Melinda Gates Foundation
Funder's Grant Number: ID OPP1176780
Keywords: Science & Technology
Life Sciences & Biomedicine
Parasitology
Tropical Medicine
Schistosomiasis
Vaccine
Cost-effectiveness
Modelling
SM-P80-BASED DNA VACCINE
MANSONI INFECTION
TRANSMISSION DYNAMICS
POPULATION-DYNAMICS
HELMINTH INFECTIONS
DISEASE-CONTROL
EGG COUNTS
BABOONS
RESPONSES
PARASITES
Cost-effectiveness
Modelling
Schistosomiasis
Vaccine
Science & Technology
Life Sciences & Biomedicine
Parasitology
Tropical Medicine
Schistosomiasis
Vaccine
Cost-effectiveness
Modelling
SM-P80-BASED DNA VACCINE
MANSONI INFECTION
TRANSMISSION DYNAMICS
POPULATION-DYNAMICS
HELMINTH INFECTIONS
DISEASE-CONTROL
EGG COUNTS
BABOONS
RESPONSES
PARASITES
Mycology & Parasitology
Tropical Medicine
1108 Medical Microbiology
1117 Public Health and Health Services
Publication Status: Published
Article Number: ARTN 499
Online Publication Date: 2019-10-23
Appears in Collections:School of Public Health