The potential impact of moxidectin on onchocerciasis elimination in Africa: an economic evaluation based on the Phase II clinical trial data

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• 作者：Hugo C Turner (1) (2)
  Martin Walker (1) (2)
  Simon K Attah (3) (4)
  Nicholas O Opoku (3)
  Kwablah Awadzi (3)
  Annette C Kuesel (5)
  Mar铆a-Gloria Bas谩帽ez (1) (2)
  
  1. London Centre for Neglected Tropical Disease Research ; Department of Infectious Disease Epidemiology ; School of Public Health ; Faculty of Medicine ; Imperial College London ; St. Mary鈥檚 Campus ; Norfolk Place ; London ; W2 1PG ; UK
  2. Department of Infectious Disease Epidemiology ; School of Public Health ; Faculty of Medicine ; Imperial College London ; St Mary鈥檚 Campus ; Norfolk Place ; London ; W2 1PG ; UK
  3. Onchocerciasis Chemotherapy Research Centre ; Hohoe ; Ghana
  4. Department of Microbiology ; University of Ghana Medical School ; Accra ; Ghana
  5. UNICEF/UNDP/World Bank/ WHO Special Programme for Research and Training in Tropical Diseases ; World Health Organization ; Geneva ; Switzerland
  
• 关键词：Onchocerciasis ; Moxidectin ; Ivermectin ; Economic evaluation ; Seasonality
• 刊名：Parasites & Vectors
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：8
• 期：1
• 全文大小：2,017 KB
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• 刊物主题：Parasitology; Infectious Diseases; Tropical Medicine; Entomology;
• 出版者：BioMed Central
• ISSN：1756-3305

文摘

Background Spurred by success in several foci, onchocerciasis control policy in Africa has shifted from morbidity control to elimination of infection. Clinical trials have demonstrated that moxidectin is substantially more efficacious than ivermectin in effecting sustained reductions in skin microfilarial load and, therefore, may accelerate progress towards elimination. We compare the potential cost-effectiveness of annual moxidectin with annual and biannual ivermectin treatment. Methods Data from the first clinical study of moxidectin were used to parameterise the onchocerciasis transmission model EPIONCHO to investigate, for different epidemiological and programmatic scenarios in African savannah settings, the number of years and in-country costs necessary to reach the operational thresholds for cessation of treatment, comparing annual and biannual ivermectin with annual moxidectin treatment. Results Annual moxidectin and biannual ivermectin treatment would achieve similar reductions in programme duration relative to annual ivermectin treatment. Unlike biannual ivermectin treatment, annual moxidectin treatment would not incur a considerable increase in programmatic costs and, therefore, would generate sizeable in-country cost savings (assuming the drug is donated). Furthermore, the impact of moxidectin, unlike ivermectin, was not substantively influenced by the timing of treatment relative to seasonal patterns of transmission. Conclusions Moxidectin is a promising new drug for the control and elimination of onchocerciasis. It has high programmatic value particularly when resource limitation prevents a biannual treatment strategy, or optimal timing of treatment relative to peak transmission season is not feasible.