Table 2.

Summary of the identified cost‐effectiveness analyses of onchocerciasis interventions

Study	Setting and time period of the intervention	Time horizon for the benefits	Discount rate	Cost year	Cost of the intervention	Effectiveness	Cost‐effectiveness ratio
McFarland & Murray 124, a	OCP	‐	‐	Not available	US$19.5 million per year. Details not available.	640 000 DALYs lost annually in absence of control. Details not available.	If all of the onchocerciasis related DALYs were eliminated, the programme would cost US$30.47 per DALY averted.
Prescott et al. 126 and Prost & Prescott 127	OCP ‐ Upper Volta (now Burkina Faso) (1975–1994)	1975–1994	10%	1977 US$	US$22.1 million. Financial costs from the programmes perceptive. Based on actual and projected OCP expenditure.	147 294 healthy life‐years added. Based on the estimated number of blindness cases prevented. Assumed that one blindness case results in 23 years healthy life lost in hyperendemic and 20 in mesoendemic areas. Assumed that blindness is associated with a disability weight of 1.	US$150 per healthy life‐year added. When not discounting the effectiveness, the results changed to US$20 per healthy life‐year added.
Evans et al. 71	OCP ‐ Burkina Faso (1974–1997)	1974–1997	10% (but varied between 3–15%)	1984 US$	US$115 million (appears to be pre‐discounting). Financial costs from the programmes perceptive. Based on actual and projected OCP expenditure.	21 567 healthy life‐years added. Based on the estimated number of blindness cases prevented. Assumed that one blindness case results in 18.7 years healthy life lost in hyperendemic and 15 in mesoendemic areas. Assumed that blindness is associated with a disability weight of 0.5.	US$2119 per healthy life‐year added (10% discount rate). When using a 3% discount rate the results changed to US$1028 per healthy life‐year added.
Benton 125	APOC (1996–2007)	1996–2017	3%	1996 US$	US$131.2 million (not clear if the costs were discounted). Financial costs from the healthcare providers perceptive. Details not specified.	9 788 304 health life‐years added. Based on the estimated number of blindness cases prevented. Assumed each case of blindness results in 20 discounted healthy life‐years lost. Assumed that blindness is associated with a disability weight of 1.	US$13.4 per healthy life‐year added.
Coffeng et al. 30	APOC (1995–2015)	1995–2015	0%	Nominal values	US$478 million. Financial costs from the programmes perceptive. Based on APOC financial reports for the World Bank.	17.4 million DALYs averted (not discounted). Estimated using a dynamic transmission model (ONCHOSIM). Used the GBD 2004 disability weights (Table 5).	US$27 per DALY averted.
Remme et al. 63	APOC (over 15 years)	Over a 25‐year period	Unclear	Not stated	US$209 million. Financial cost from the healthcare providers perceptive. Source not stated.	At least 26 million DALYs averted. Estimated using a back of the envelope calculation. Details on the DALY calculation/weights not given.	Approximately US$7 per DALY averted.
Turner et al. 73	Annual MDA in an African savannah setting (up to 50 years)b , c	50 years	3%	2012 US$	US$0.55–1.07 million per 100 000 – depending on the assumed endemicity levelc. Assumed that once the pOTTIS was achieved, MDA would be stoppedb. Economic cost from the healthcare providers perspective (not including the value of the donated ivermectin). Based on a costing study in Ghana 44.	37 858–331 632 DALYs averted per 100 000 –depending on the assumed endemicity levelc. Estimated using a dynamic transmission model (EPIONCHO). Used the GBD 2004 disability weights (Table 5). Included the excess mortality associated with heavy infections 83.	US$3–15 per DALY averted – depending on the assumed endemicity levelc. Results changed to US$29–133 per DALY averted when including the additional economic value of the donated ivermectin. If elimination not achieved the results for the lowest endemicity setting would change from US$15 to US$28 per DALY averted.
Turner et al. 73	Biannual MDA in an African savannah setting (up to 50 years)b , c	50 years	3%	2012 US$	US$0.63–1.20 million per 100 000 – depending the assumed endemicity levelc. Incremental to annual treatment: US$0.07–0.13 million per 100 000. Assumed that once the pOTTIS was achieved, MDA would be stoppedb. Economic cost from the healthcare providers perspective (not including the value of the donated ivermectin). Based on a costing study in Ghana 44.	38 585–342 229 DALYs averted per 100 000 –depending the assumed endemicity levelc. Incremental to annual treatment: 727–10 597 per 100 000. Estimated using a dynamic transmission model (EPIONCHO). Used the GBD 2004 disability weights (Table 5). Included the excess mortality associated with heavy infections 83.	Incremental cost‐effectiveness ratio: US$12–100 per incremental DALY averted – depending on the assumed endemicity levelc. Results changed to US$334–2674 per incremental DALY averted when including the additional economic value of the donated ivermectin.

APOC, African Programme for Onchocerciasis Control; DALY, disability‐adjusted life years; MDA, mass drug administration; Nominal cost, values have not been adjusted for inflation; OCP, Onchocerciasis Control Programme in West Africa; pOTTIS, provisional operational thresholds for treatment interruption followed by surveillance.

^aInformation for this study was taken from Waters et al. 18.

^bAssumed that MDA would be stopped (determining the programme duration and its total cost) once the pOTTIS would have been achieved (defined as the modelled microfilarial prevalence being <1.4%, measured just before the next treatment round).

^cThree different endemicity levels were explored (ranging between 40–80% microfilarial prevalence).