Benchmarking the Cost per Person of Mass Treatment for Selected Neglected Tropical Diseases: An Approach Based on Literature Review and Meta-regression with Web-Based Software Application

Background
Advocacy around mass treatment for the elimination of selected Neglected Tropical Diseases (NTDs) has typically put the cost per person treated at less than US$ 0.50. Whilst useful for advocacy, the focus on a single number misrepresents the complexity of delivering “free” donated medicines to about a billion people across the world. We perform a literature review and meta-regression of the cost per person per round of mass treatment against NTDs. We develop a web-based software application (https://healthy.shinyapps.io/benchmark/) to calculate setting-specific unit costs against which programme budgets and expenditures or results-based pay-outs can be benchmarked.
Methods
We reviewed costing studies of mass treatment for the control, elimination or eradication of lymphatic filariasis, schistosomiasis, soil-transmitted helminthiasis, onchocerciasis, trachoma and yaws. These are the main 6 NTDs for which mass treatment is recommended. We extracted financial and economic unit costs, adjusted to a standard definition and base year. We regressed unit costs on the number of people treated and other explanatory variables. Regression results were used to “predict” country-specific unit cost benchmarks.
Results
We reviewed 56 costing studies and included in the meta-regression 34 studies from 23 countries and 91 sites. Unit costs were found to be very sensitive to economies of scale, and the decision of whether or not to use local volunteers. Financial unit costs are expected to be less than 2015 US$ 0.50 in most countries for programmes that treat 100 thousand people or more. However, for smaller programmes, including those in the “last mile”, or those that cannot rely on local volunteers, both economic and financial unit costs are expected to be higher.
Discussion
The available evidence confirms that mass treatment offers a low cost public health intervention on the path towards universal health coverage. However, more costing studies focussed on elimination are needed. Unit cost benchmarks can help in monitoring value for money in programme plans, budgets and accounts, or in setting a reasonable pay-out for results-based financing mechanisms.

背景
针对特定被忽视的热带病（Neglected Tropical Diseases, NTDs）消除工作开展的群体性治疗倡导活动，通常将单人治疗成本设定在0.50美元以下。尽管这一数值对倡导工作具有一定价值，但仅聚焦单一数值，实则掩盖了向全球约10亿人免费捐赠药品的执行复杂性。本研究开展了文献综述与元回归分析，针对每轮群体性治疗的人均成本与NTDs的关联展开研究。此外，我们开发了一款基于网页的软件应用（https://healthy.shinyapps.io/benchmark/），可针对特定场景计算单位成本，用于项目预算、支出或基于结果的付费基准比对。
方法
我们回顾了针对淋巴丝虫病、血吸虫病、土源性蠕虫病、盘尾丝虫病、沙眼与雅司病的控制、消除或根除所开展的群体性治疗成本研究。上述6类为推荐开展群体性治疗的主要NTDs。我们提取了财务与经济单位成本，并按照标准定义与基准年进行调整。将单位成本作为因变量，以接受治疗的人数及其他解释变量作为自变量开展回归分析。利用回归结果“预测”得到各国专属的单位成本基准值。
结果
本次研究共检索到56项成本研究，最终纳入元回归分析的有来自23个国家、91个研究地点的34项研究。研究发现，单位成本对规模经济及是否使用本地志愿者的决策极为敏感。对于治疗人数达10万人及以上的项目，多数国家的财务单位成本预计低于2015年美元计价的0.50美元。然而，针对规模较小的项目（包括“最后一公里”项目），或无法依赖本地志愿者的项目，其经济与财务单位成本预计均会更高。
讨论
现有证据证实，群体性治疗是迈向全民健康覆盖进程中一项低成本的公共卫生干预手段。然而，仍需更多聚焦于消除工作的成本研究。单位成本基准可用于监测项目计划、预算与账务中的资金使用效益，或为基于结果的融资机制设定合理的付费标准。