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. 2017 Apr 20;11(4):e0005457. doi: 10.1371/journal.pntd.0005457

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.