Background Concerns that annual mass administration of ivermectin, the predominant strategy for onchocerciasis control and elimination, may not lead to elimination of parasite transmission (EoT) in all endemic areas have increased interest in alternative treatment strategies. One such strategy is moxidectin. We performed an updated economic assessment of moxidectin- relative to ivermectin-based strategies. Methods We investigated annual and biannual community-directed treatment with ivermectin (aCDTI, bCDTI) and moxidectin (aCDTM, bCDTM) with minimal or enhanced coverage (65% or 80% of total population taking the drug, respectively) in intervention-naive areas with 30%, 50%, or 70% microfilarial baseline prevalence (representative of hypo-, meso-, and hyperendemic areas). We compared programmatic delivery costs for the number of treatments achieving 90% probability of EoT (EoT90), calculated with the individual-based stochastic transmission model EPIONCHO-IBM. We used the costs for 40 years of program delivery when EoT90 was not reached earlier. The delivery costs do not include drug costs. Results aCDTM and bCDTM achieved EoT90 with lower programmatic delivery costs than aCDTI with 1 exception: aCDTM with minimal coverage did not achieve EoT90 in hyperendemic areas within 40 years. With minimal coverage, bCDTI delivery costs as much or more than aCDTM and bCDTM. With enhanced coverage, programmatic delivery costs for aCDTM and bCDTM were lower than for aCDTI and bCDTI. Conclusions Moxidectin-based strategies could accelerate progress toward EoT and reduce programmatic delivery costs compared with ivermectin-based strategies. The costs of moxidectin to national programs are needed to quantify whether delivery cost reductions will translate into overall program cost reduction.

中文翻译：

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消除盘尾丝虫病莫昔克汀治疗策略的最新经济评估

背景 由于担心每年大规模施用伊维菌素（控制和消除盘尾丝虫病的主要策略）可能无法消除所有流行地区的寄生虫传播（EoT），人们对替代治疗策略的兴趣日益浓厚。其中一种策略是莫昔克汀。我们对莫昔克汀相对于伊维菌素策略进行了更新的经济评估。方法 我们调查了伊维菌素（aCDTI、bCDTI）和莫昔克丁（aCDTM、bCDTM）每年一次和每两年一次的社区指导治疗，在未进行干预的地区采用最小覆盖率或增强覆盖率（分别占总人口的 65% 或 80%）微丝蚴基线流行率为 30%、50% 或 70%（代表低流行区、中流行区和高流行区）。我们比较了实现 90% EoT 概率 (EoT90) 的治疗次数的程序化交付成本，这是使用基于个体的随机传输模型 EPIONCHO-IBM​​ 计算得出的。当 EoT90 未提前达到时，我们使用了 40 年计划交付的成本。运送费用不包括药品费用。结果 aCDTM 和 bCDTM 以比 aCDTI 更低的计划交付成本实现了 EoT90，但有 1 个例外：覆盖范围极小的 aCDTM 在 40 年内没有在高流行地区实现 EoT90。由于覆盖范围极小，bCDTI 的交付成本与 aCDTM 和 bCDTM 相同甚至更高。随着覆盖范围的扩大，aCDTM 和 bCDTM 的程序化交付成本低于 aCDTI 和 bCDTI。结论 与基于伊维菌素的策略相比，基于莫昔克丁的策略可以加速 EoT 的进展并降低程序化交付成本。需要了解莫昔克丁对国家计划的成本，以量化交付成本的降低是否会转化为总体计划成本的降低。