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An economic evaluation of strategies for sleeping sickness elimination

INTRO/BACKGROUND Human African trypanosomiasis (HAT), also known as sleeping sickness, is an important vector-borne parasitic disease that exclusively affects sub-Saharan Africa. The disease is fatal if not treated. Control strategies did not much evolve since colonial times, until in recent decades when a spur of innovation delivered new rapid diagnostic tests, tiny targets as a novel vector control strategies and, most importantly, fexinidazole, as an oral treatment. The World Health Organization has targeted HAT for elimination as a public health problem by 2020 and aims for zero transmission by 2030. Though the number of cases globally has dwindled from over 30 000 in 1998 to less than 1200 in 2017, the maintenance of this achievement is a huge challenge, given the donor support might shift to other health priorities. This thesis focuses on the economic evaluation of current novel intervention strategies, to best advise HAT elimination policy.
OBJECTIVES. This PhD project aims to document the costs and cost-effectiveness of different approaches to screening, treatment and vector control for HAT in the Democratic Republic of Congo. The first objective of the thesis will be to generate primary cost data in order to be able to estimate the economic cost of the current control interventions and the second part shall be dedicated to studying what the overall cost and efficiency would be for the implementation of the different HAT control scenarios under consideration in the DRC and their public health implications.
METHODS. The economic costs, from a health care provider perspective, will be estimated for the different HAT control strategies using a combination of bottom-up costing and step-down costing. The endpoints measured are the cost per person screened, diagnosed and treated, as well as the costs for vector control expressed as the cost per km and km² covered. A decision analysis model will be developed allowing for generalization across diverse settings by combining the cost data with epidemiological information to assess the expected costs and health outcomes of decision alternatives.
RELEVANCE. The data generated in this thesis will support the decision making process regarding global HAT elimination policies by providing information regarding the costs and potential health outcomes of different HAT control strategies.
Datum:3 jul 2019 →  Heden