Table 1. Examples of questions decision makers may ask and models that have answered such questions.
Example Questions | Example Models |
---|---|
How significant is an NTD, and how much time, effort, and resources should be dedicated to prevention and control? | Globally, human hookworm infection costs society US$7.5 billion to US$138.9 billion in 2016 and results in 4.1 million DALYs. The cost per hookworm infection varies by geographic region, from US$99 in Southeast Asia to US$447 in the Americas.[8] |
What is the impact of an NTD on different locations, sectors, and industries? | Chagas disease cost US$627 million in health care costs and US$7 billion in societal costs. Annually, an infected individual costs US$4,059 in Latin America, US$13,580 in Europe, and US$15,762 in the United States, Canada, and Australia.[4] |
What level of control (e.g., eradication, elimination, or long-term control) of the NTD is possible? | MDA for lymphatic filariasis would need to be drastically scaled up (85% coverage rate with all countries treating 100% of at-risk population annually) to achieve eradication. Maintaining current rates would mean eradiation would not be possible until 2050, with the last round of MDA being given then.[9] |
Which existing policies, products, and strategies should be used to prevent and control an NTD? | A combination of treatment of infective individuals and insecticide spraying was the most effective and cost-effective (economically dominant) method of control for visceral leishmaniasis. Insecticide spraying would require less effort when used in combination with treatment policies.[10] |
What new policies, products, and strategies for NTD prevention and control should be developed and what should be their characteristics? | A human hookworm vaccine would be more cost-effective than currently used MDA except when vaccination was less efficacious (20% efficacy, 5-year duration) and MDA coverage was 75%. The prevalence in children decreased to 14.6% after 20 years with vaccination, compared to 54.1% with MDA.[5] |
How should NTD policies, products, or strategies be implemented? | Hookworm vaccination in combination with drug treatment would be cost-effective when vaccinating both school-aged children and women of child-bearing age but may yield a greater economic return among school-aged children, as the coverage may be greater in this population.[11] |
How much should be invested in the development of new policies, products, and strategies for NTD prevention and control? | The return-on-investment for a therapeutic Chagas vaccine would reach US$2 million to US$18 million if 3% of the target population is vaccinated and development costs were $100 million or if 11% are vaccinated and development costs were $400 million.[12] |
How should a population be screened for a NTD? | Screening Latin American pregnant women and their newborns for Chagas disease in nonendemic settings economically dominated (cost less and provided health benefits) no screening. Even at a low prevalence of Chagas (0.9%) with a low probability of vertical transmission (2.24%), screening was still better than no screening at a cost of €37.5 per test.[13] |
What should be the price of a NTD product or service? | To cost less to avert a case than the cost of treatment, a vaccine for cutaneous leishmaniasis that is US$0.5 per dose (2 doses) would need to have an efficacy of 70% and 5-year protection duration with a ≥0.1% infection risk.[14] |
Which of the available NTD policies, products, and strategies should be used? | Among four drug treatment regimens currently used for visceral leishmaniasis, amphotericin B deoxycholate was the most effective, averting 87.2% of attributable deaths, while miltefosine was the most cost-effective.[15] |
DALY, disability-adjusted life year; MDA, mass drug administration; NTD, neglected tropical disease.