Economic Evaluation of gambiense Human African Trypanosomiasis Elimination Campaigns in Five Distinct Transmission Settings in the Democratic Republic of Congo

Background: Gambiense human African trypanosomiasis (gHAT) is marked for elimination of transmission (EOT) by 2030, but the disease persists in several low-income countries. We examine the cost-effectiveness of four gHAT elimination strategies in Democratic Republic of Congo (DRC), which has the highest burden of gHAT. Methods: We compared four strategies against gHAT by coupling a transmission model with a health outcomes model in five settings – spanning low- to high-risk. Alongside passive surveillance (PS) in fixed health facilities, the strategies included active screening (AS) at average or high coverage levels, both alone or with vector control (VC). A scale-back algorithm was devised to simulate cessation of AS and VC when no cases were reported for three consecutive years. Outcomes were denominated in disability-adjusted life-years (DALYs) and costs until 2040 were denominated in 2018 US$. Results: In high or moderate-risk settings, costs of gHAT strategies are primarily driven by AS and, if used, VC. Due to the cessation of AS and VC most investments (75-80%) will be made by 2030 and VC might be cost-saving while ensuring EOT. In low-risk settings, costs are driven by PS, and minimum-cost strategies consisting of AS and PS lead to EOT by 2030 with high probability. Conclusion: In many settings, the case for EOT by 2030 is a sensible use of resources, and investments in gHAT will decelerate within this decade in moderate- and low-risk regions. Funding Statement: This work was supported by the Bill and Melinda Gates Foundation (www.gatesfoundation.org) through the Human African Trypanosomiasis Modelling and Economic Predictions for Policy (HAT MEPP) project [OPP1177824] (MA, CH, REC, PB, MJK, KSR, and FT), through the NTD Modelling Consortium [OPP1184344, OPP1156227, and OPP1186851] (KSR and MJK), and through the TRYP-ELIM-BANDUNDU project [OPP1155293] (EMM and RS) and the Directorate-general Development Cooperation and Humanitarian Aid (EMM). Declaration of Interests: The authors have no conflicts of interest to disclose. Ethics Approval Statement: Due to the anonymised and aggregated nature of the gHAT case data, no ethical approval was required for secondary use of routinely collected national programme data. Costs were modeled based on freely available data in the literature, and therefore, this study is exempt from ethics board approval.