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ORIGINAL RESEARCH article

Front. Health Serv.
Sec. Implementation Science
Volume 4 - 2024 | doi: 10.3389/frhs.2024.1279762
This article is part of the Research Topic Improving Services for Neglected Tropical Diseases: Ending the Years of Neglect View all 5 articles

Cost-effectiveness of mass drug administration for control of scabies in Ethiopia: a decision-analytic model

Provisionally accepted
Natalia Hounsome Natalia Hounsome 1*Robel Yirgu Robel Yirgu 2,3Jo Middleton Jo Middleton 4Jackie A. Cassell Jackie A. Cassell 4Abebaw Fekadu Abebaw Fekadu 3,5Gail Davey Gail Davey 1
  • 1 Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, England, United Kingdom
  • 2 Brighton and Sussex Medical School, Brighton, England, United Kingdom
  • 3 Center for Innovative Drug Development and Therapeutic Trials, Addis Ababa, Addis Ababa, Ethiopia
  • 4 Department of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, England, United Kingdom
  • 5 School of Public Health, College of Health Science, Addis Ababa University, Addis Ababa, Addis Ababa, Ethiopia

The final, formatted version of the article will be published soon.

    The strategies to control scabies in highly endemic populations include individual case/household management and mass drug administration (MDA). We used a decision-analytic model to compare ivermectin-based MDA and individual case/household management (referred to as "usual care") for control of scabies in Ethiopia at different prevalence thresholds for commencing MDA.A decision-analytic model was based on a repeated population survey conducted in Northern Ethiopia in 2018-2020, which aimed to evaluate the secondary impact of singledose ivermectin MDA for the control of onchocerciasis on scabies prevalence. The model estimates the number of scabies cases and costs of two treatment strategies (MDA and usual care) based on their effectiveness, population size, scabies prevalence, compliance with MDA, medication cost, and other parameters.In the base-case analysis with a population of 100,000 and scabies prevalence of 15%, the MDA strategy was both more effective and less costly than usual care. The probability of MDA being cost-effective at the current cost-effectiveness threshold (equivalent to the cost of usual care) was 85%. One-way sensitivity analyses showed that the MDA strategy remained dominant (less costly and more effective) in 22 out of 26 scenarios. MDA was not cost-effective at scabies prevalence <10%, MDA effectiveness <85% and population size <5,000. An increase in the cost of ivermectin from 0 (donated) to 0.54 US$/dose resulted in a decrease in the probability of MDA being cost-effective from 85% to 17%. At 0.25 US$/dose, the MDA strategy was no longer cost-effective.The model provides robust estimates of the costs and outcomes of MDA and usual care and can be used by decision-makers for planning and implementing scabies control programmes. Results of our analysis suggest that single-dose ivermectin MDA is cost-effective in scabies control and can be initiated at a scabies prevalence >10%.

    Keywords: scabies, mass drug administration, Ethiopia, cost-effectiveness Abbreviations API, active pharmaceutical ingredient, DALY, Disability-adjusted life year, ICER, incremental cost-effectiveness ratio, MDA, mass drug administration, NTD, neglected tropical disease

    Received: 18 Aug 2023; Accepted: 04 Sep 2024.

    Copyright: © 2024 Hounsome, Yirgu, Middleton, Cassell, Fekadu and Davey. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Natalia Hounsome, Brighton and Sussex Centre for Global Health Research, Brighton and Sussex Medical School, Brighton, BN1 9PX, England, United Kingdom

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.