Is eliminating lymphatic filariasis money well spent?

13 Mar 2017
Sensitivity of the cost-effectiveness of preventive chemotherapy to the assumed average treatment cost.

In 2000, around 120 million people were infected with lymphatic filariasis (LF).  Commonly known as elephantiasis, LF impairs the lymphatic system and can lead to the abnormal enlargement of body parts, causing pain, severe disability and disfigurement (which can be associated with social stigma and exclusion). The debilitating nature of the disease reduces economic productivity of sufferers by limiting educational and employment opportunities.

The World Health Organization has targeted the elimination of LF as a public health problem by 2020. The cost to achieve this goal is an estimated $154 million every year from 2015 until 2020.

The cost-effectiveness of this investment is the subject a new analysis undertaken by a team of researchers drawn from across academia, public health and the pharmaceutical industry.

To eliminate LF as a public health problem by 2020, the WHO established the Global Programme to Eliminate Lymphatic Filariasis (GPELF) which pursued a programme of preventive chemotherapy and corrective surgery called hydrocelectomy.  Between 2000 and 2014, GPELF has delivered more than 5.6 billion chemotherapy treatments. Using  data collected over this period, researchers were able to predict the cost-effectiveness of the GPELF approach.

The analysis looked at both the total cost of providing the treatments and health and economic benefits experienced by those treated between 2000-2014. The researchers also developed a model to investigate the number of disability-adjusted life years (DALYs) averted hydrocelectomy, and identified the cost threshold under which it would be considered cost-effective.

The findings show that both preventive chemotherapy and hydrocele surgeries provided under the GPELF are incredibly cost-effective and offer a very good investment in public health.

In a low income country, a hydrocelectomy would be classed as highly cost-effective if the cost of surgery is less than $66, and classed as cost-effective if less than $398.

Table 2: Cost-effectiveness ratios of the preventive chemotherapy provided under the GPELF between 2000-2014
Costs type Cost per Daly averted
Financial Costs $ 24 (12-39)
Economic costs –  excluding the donated drugs value $ 29 (14-48)
Economic costs –  including the donated drugs value $ 64 (49-83)

Download the paper

Hugo C. Turner, Alison A. Bettis, Brian K. Chu, Deborah A. McFarland, Pamela J. Hooper, Sunny D. Mante, Christopher Fitzpatrick, Mark H. Bradley. Investment Success in Public Health: An Analysis of the Cost-Effectiveness and Cost-Benefit of the Global Programme to Eliminate Lymphatic Filariasis. Clinical Infectious Diseases, 10 December 2016 Vol.64 (6)  728-735