Cost-effectiveness of triple drug administration (TDA) with praziquantel, ivermectin and albendazole for the prevention of neglected tropical diseases in Nigeria

Abstract

Onchocerciasis, lymphatic filariasis (LF), schistosomiasis and soil transmitted, helminthiasis (STH) are all co-endemic in Nigeria. Annual mass drug administration (MDA) with ivermectin (for onchocerciasis), albendazole (for STH and with ivermectin for LF) and praziquantel (for schistosomiasis) is the WHO-recommended treatment strategy for preventive chemotherapy. Separate delivery rounds for distribution of these drugs have been the usual approach to MDA. All three drugs, however, have now been shown to be clinically and programmatically safe for co-administration with what has come to be known as triple drug administration (TDA). We examined the cost savings of converting from separate delivery rounds to TDA in two states in Nigeria. In 2008, eight local government areas received a single round of ivermectin with albendazole followed at least 1 week later by a single round of praziquantel to school-aged children. The following year, a single round was administered with TDA. The number of treated individuals was essentially unchanged during both years (1 301 864 in 2008 and 1 297 509 in 2009) and no change in adverse events was reported. The total programmatic costs for the MDA, not including drug and overhead costs, reduced by 41% from $123, 624 to $72, 870. Cost savings were limited in larger populations due to economies of scale. TDA is recommended for mature MDA.

We would like to thank the following individuals: David Alheri, Falam Jip Nimzing, Bulus Mancha, Priscillia Dogoyaro, John Umaru, Alkali Anzaks, Don Denard, all the MOH-integrated health team members in Plateau and Nasarawa states and all the Communities and Community Directed Distributors without whom none of this work would be possible. Mass drug administration was carried out with support from The Bill & Melinda Gates Foundations, GlaxoSmithKline, Merck & Co. and the World Health Organization. The Carter Center works in close collaboration with Federal and State Ministries of Health.