{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:19:46Z","timestamp":1790162386725,"version":"4.1.0"},"reference-count":38,"publisher":"BMJ","issue":"2","funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["Eradication Investment Case (EIC) of onchocheriasi"],"award-info":[{"award-number":["Eradication Investment Case (EIC) of onchocheriasi"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2019,3,9]]},"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Programme to eliminate neglected tropical diseases (NTDs) have gained global recognition, and may allow for improvements to universal health coverage and poverty alleviation. It is hoped that elimination of human African trypanosomiasis (HAT) <jats:italic>Trypanosoma brucei gambiense (Tbg<\/jats:italic>) would assist in this goal, but the financial costs are still unknown. The objective of this analysis was to forecast the financial burden of direct costs of HAT <jats:italic>Tbg<\/jats:italic> to funders and society.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In order to estimate the total costs to health services and individuals: (1) potential elimination programmes were defined; (2) the direct costs of programmes were calculated; (3) the per case out-of-pocket payments (OOPs) by programme and financial risk protection indicators were estimated. The total estimated costs for control and elimination programme were reported up till 2020 in international dollars. The mean results for both direct programme costs and OOPs were calculated and reported along with 95% CIs.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Across sub-Saharan Africa, HAT <jats:italic>Tbg<\/jats:italic> maintaining \u2018Control\u2019 would lead to a decline in cases and cost US$630.6\u2009million. In comparison, the cost of \u2018Elimination\u2019 programme ranged from US$410.9\u2009million to US$1.2\u2009billion. Maintaining \u2018Control\u2019 would continue to cause impoverishment and financial hardship to households; while all \u2018Elimination\u2019 programme would lead to significant reductions in poverty.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Overall, the total costs of either control or elimination programme would be near US$1\u2009billion in the next decade. However, only elimination programme will reduce the number of cases and improve financial risk protection for households who are impacted by HAT <jats:italic>Tbg<\/jats:italic>.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2018-001173","type":"journal-article","created":{"date-parts":[[2019,4,15]],"date-time":"2019-04-15T07:45:10Z","timestamp":1555314310000},"page":"e001173","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Is the elimination of \u2018sleeping sickness\u2019 affordable? Who will pay the price? Assessing the financial burden for the elimination of human African trypanosomiasis <i>Trypanosoma brucei gambiense<\/i> in sub-Saharan Africa"],"prefix":"10.1136","volume":"4","author":[{"given":"C Simone","family":"Sutherland","sequence":"first","affiliation":[{"name":"Institute of Pharmaceutical Medicine, Universitat Basel Medizinische Fakultat, Basel, Switzerland"},{"name":"Department of Epidemiology and Public Health (EPH), Swiss Tropical and Public Health Institute, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8671-9400","authenticated-orcid":false,"given":"Fabrizio","family":"Tediosi","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Public Health (EPH), Swiss Tropical and Public Health Institute, Basel, Switzerland"},{"name":"Department of Public Health, University of Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,4,14]]},"reference":[{"key":"2025072913314655000_4.2.e001173.1","unstructured":"World Health Organization . Global Health Expenditure Database. Available: http:\/\/apps.who.int\/nha\/database\/Regional_Averages\/Index\/en [Accessed cited 2018 Apr 5]."},{"key":"2025072913314655000_4.2.e001173.2","unstructured":"Uniting to Combat Neglected Tropical Diseases . Reaching the unreached: fourth progress report of the London Declaration, 2016. Available: http:\/\/unitingtocombatntds.org\/report\/fourth-report-reaching-unreached"},{"key":"2025072913314655000_4.2.e001173.3","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0002446","article-title":"Developing eradication investment cases for onchocerciasis, lymphatic filariasis, and human African trypanosomiasis: rationale and main challenges","volume":"7","author":"Tediosi","year":"2013","journal-title":"PLoS Negl Trop Dis"},{"key":"2025072913314655000_4.2.e001173.4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0004147","article-title":"What is needed to eradicate lymphatic filariasis? a model-based assessment on the impact of scaling up mass drug administration programs","volume":"9","author":"Kastner","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"2025072913314655000_4.2.e001173.5","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2015-000021","article-title":"Modelling the health impact and cost-effectiveness of lymphatic filariasis eradication under varying levels of mass drug administration scale-up and geographic coverage","volume":"1","author":"Stone","year":"2016","journal-title":"BMJ Glob Health"},{"key":"2025072913314655000_4.2.e001173.6","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0005934","article-title":"How much will it cost to eradicate lymphatic filariasis? An analysis of the financial and economic costs of intensified efforts against lymphatic filariasis","volume":"11","author":"Kastner","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"key":"2025072913314655000_4.2.e001173.7","doi-asserted-by":"crossref","unstructured":"Kastner RJ , Stone CM , Steinmann P , et al . Lessons learned from developing an eradication investment case for lymphatic filariasis. In: Advances in parasitology, 2016: 393\u2013417. (cited 2018 Apr 5).","DOI":"10.1016\/bs.apar.2016.08.004"},{"key":"2025072913314655000_4.2.e001173.8","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0003664","article-title":"Control, elimination, and eradication of river blindness: scenarios, timelines, and ivermectin treatment needs in Africa","volume":"9","author":"Kim","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"2025072913314655000_4.2.e001173.9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0004056","article-title":"Financial and economic costs of the elimination and eradication of onchocerciasis (river blindness) in Africa","volume":"9","author":"Kim","year":"2015","journal-title":"PLoS Negl Trop Dis"},{"key":"2025072913314655000_4.2.e001173.10","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2016-000158","article-title":"Modelling the health and economic impacts of the elimination of river blindness (onchocerciasis) in Africa","volume":"2","author":"Kim","year":"2017","journal-title":"BMJ Glob Health"},{"key":"2025072913314655000_4.2.e001173.11","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2014.302454"},{"key":"2025072913314655000_4.2.e001173.12","doi-asserted-by":"crossref","first-page":"e69","DOI":"10.1016\/S2214-109X(16)30237-6","article-title":"Seeing beyond 2020: an economic evaluation of contemporary and emerging strategies for elimination of Trypanosoma brucei gambiense","volume":"5","author":"Sutherland","year":"2017","journal-title":"Lancet Glob Health"},{"key":"2025072913314655000_4.2.e001173.13","first-page":"275","article-title":"Ethical considerations for global health decision-making: Justice-Enhanced cost-effectiveness analysis of new Technologies for Trypanosoma brucei gambiense","volume":"14","author":"Merritt","year":"2018","journal-title":"Public Health Ethics"},{"key":"2025072913314655000_4.2.e001173.14","unstructured":"WHO . Who technical report series 984: control and surveillance of human African trypanosomiasis, 2013. Available: http:\/\/apps.who.int\/iris\/bitstream\/10665\/95732\/1\/9789241209847_eng.pdf"},{"key":"2025072913314655000_4.2.e001173.15","unstructured":"Uniting to Combat NTDs . The Third Report: Country Leadership and Collaboration on NTDs. Available: http:\/\/unitingtocombatntds.org\/report\/third-report-country-leadership-and-collaboration-ntds [Accessed 08 Apr 2016]."},{"key":"2025072913314655000_4.2.e001173.16","first-page":"e1467","volume-title":"PLoS neglected tropical diseases","volume":"6","author":"Mpanya","year":"2012"},{"key":"2025072913314655000_4.2.e001173.17","unstructured":"World Health Organization (WHO) . Global health Observatory Data Repository [Accessed 07 Jul 2015]."},{"key":"2025072913314655000_4.2.e001173.18","doi-asserted-by":"crossref","unstructured":"Simarro PP , Cecchi G , Franco JR , et al . Mapping the capacities of fixed health facilities to cover people at risk of gambiense human African trypanosomiasis. Int J Health Geogr 2014;13.doi:10.1186\/1476-072X-13-4","DOI":"10.1186\/1476-072X-13-4"},{"key":"2025072913314655000_4.2.e001173.19","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12483"},{"key":"2025072913314655000_4.2.e001173.20","doi-asserted-by":"crossref","unstructured":"Stone CM , Chitnis N . Implications of heterogeneous biting exposure and animal hosts on trypanosomiasis brucei gambiense transmission and control. PLoS Comput Biol. In Press 2015.","DOI":"10.1371\/journal.pcbi.1004514"},{"key":"2025072913314655000_4.2.e001173.21","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S39728"},{"key":"2025072913314655000_4.2.e001173.22","unstructured":"Depetris Chauvin N , Mulangu F , Porto GG . Food production and consumption trends in sub-Saharan Africa: prospects for the transformation of the agricultural sector. Regional Bureau for Africa: United Nations Development Programme, 2012."},{"key":"2025072913314655000_4.2.e001173.23","doi-asserted-by":"publisher","DOI":"10.3201\/eid1302.060075"},{"key":"2025072913314655000_4.2.e001173.24","first-page":"e868","volume-title":"PLoS neglected tropical diseases","volume":"4","author":"Matemba","year":"2010"},{"key":"2025072913314655000_4.2.e001173.25","unstructured":"International Monetary Fund (IMF) . World economic outlook database, 2014. Available: http:\/\/www.imf.org\/external\/pubs\/ft\/weo\/2014\/01\/weodata\/index.aspx [Accessed 12 Sep 2014]."},{"key":"2025072913314655000_4.2.e001173.26","unstructured":"European Central Bank (Eurosystem) . ECB statistical data Warehouse, 2014. Available: http:\/\/sdw.ecb.europa.eu\/ [Accessed 12 Sep 2014]."},{"key":"2025072913314655000_4.2.e001173.27","unstructured":"Patient Engagement HIT.com . 64% of Patients Avoid Care Due to High Patient Healthcare Costs. Available: https:\/\/patientengagementhit.com\/news\/64-of-patients-avoid-care-due-to-of-high-patient-healthcare-costs [Accessed 05 Apr 2018]."},{"key":"2025072913314655000_4.2.e001173.28","unstructured":"Bank TW . Tracking universal health coverage : 2017 global monitoring report, 2017. Available: http:\/\/documents.worldbank.org\/curated\/en\/640121513095868125\/Tracking-universal-health-coverage-2017-global-monitoring-report [Accessed 20 Apr 2018]."},{"key":"2025072913314655000_4.2.e001173.29","doi-asserted-by":"crossref","unstructured":"Lejon V , Jacobs J , Simarro PP . Elimination of sleeping sickness hindered by difficult diagnosis. Bull World Health Organ 2013;91.doi:10.2471\/BLT.13.126474","DOI":"10.2471\/BLT.13.126474"},{"key":"2025072913314655000_4.2.e001173.30","first-page":"e2003","volume-title":"PLoS neglected tropical diseases","volume":"7","author":"Palmer","year":"2013"},{"key":"2025072913314655000_4.2.e001173.31","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0006002","article-title":"The socio-economic burden of human African trypanosomiasis and the coping strategies of households in the south western Kenya foci","volume":"11","author":"Bukachi","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"key":"2025072913314655000_4.2.e001173.32","doi-asserted-by":"publisher","DOI":"10.1002\/hec.776"},{"key":"2025072913314655000_4.2.e001173.33","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0006250","article-title":"Socioeconomic benefit to individuals of achieving 2020 targets for four neglected tropical diseases controlled\/eliminated by innovative and intensified disease management: human African trypanosomiasis, Leprosy, visceral Leishmaniasis, Chagas disease","volume":"12","author":"Lenk","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"key":"2025072913314655000_4.2.e001173.34","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1016\/S0140-6736(17)32758-7","article-title":"Oral fexinidazole for late-stage African Trypanosoma brucei gambiense trypanosomiasis: a pivotal multicentre, randomised, non-inferiority trial","volume":"391","author":"Mesu","year":"2018","journal-title":"The Lancet"},{"key":"2025072913314655000_4.2.e001173.35","unstructured":"Drugs for Neglected Diseases initiative (DNDi) . The last steps towards innovative oral therapies, 2017. Available: www.dndi.org [Accessed 01 May 2018]."},{"key":"2025072913314655000_4.2.e001173.36","unstructured":"FIND . Implementation of HAT diagnostics. Available: https:\/\/www.finddx.org\/ntd\/hatprojects\/implementation-of-hat-diagnostics\/ [Accessed 01 May 2018]."},{"key":"2025072913314655000_4.2.e001173.37","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0005585","article-title":"Monitoring the elimination of human African trypanosomiasis: update to 2014","volume":"11","author":"Franco","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"key":"2025072913314655000_4.2.e001173.38","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0003624","article-title":"Costs of using \"tiny targets\" to control Glossina fuscipes fuscipes, a vector of gambiense sleeping sickness in Arua District of Uganda","volume":"9","author":"Shaw","year":"2015","journal-title":"PLoS Negl Trop Dis"}],"container-title":["BMJ Global Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjgh-2018-001173","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T20:31:55Z","timestamp":1753821115000},"score":1,"resource":{"primary":{"URL":"https:\/\/gh.bmj.com\/lookup\/doi\/10.1136\/bmjgh-2018-001173"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4]]},"references-count":38,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019,4,14]]},"published-print":{"date-parts":[[2019,4]]}},"alternative-id":["10.1136\/bmjgh-2018-001173"],"URL":"https:\/\/doi.org\/10.1136\/bmjgh-2018-001173","relation":{},"ISSN":["2059-7908"],"issn-type":[{"value":"2059-7908","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4]]}}}