Background The Global Programme to Eliminate Lymphatic Filariasis (GPELF) aims to reduce and maintain infection levels through mass drug administration (MDA), but there is evidence of ongoing transmission after MDA in areas where Culex mosquitoes are the main transmission vector, suggesting that a more stringent criterion is required for MDA decision making in these settings. Methods We use a transmission model to investigate how a lower prevalence threshold (<1% antigenemia [Ag] prevalence compared with <2% Ag prevalence) for MDA decision making would affect the probability of local elimination, health outcomes, the number of MDA rounds, including restarts, and program costs associated with MDA and surveys across different scenarios. To determine the cost-effectiveness of switching to a lower threshold, we simulated 65% and 80% MDA coverage of the total population for different willingness to pay per disability-adjusted life-year averted for India ($446.07), Tanzania ($389.83), and Haiti ($219.84). Results Our results suggest that with a lower Ag threshold, there is a small proportion of simulations where extra rounds are required to reach the target, but this also reduces the need to restart MDA later in the program. For 80% coverage, the lower threshold is cost-effective across all baseline prevalences for India, Tanzania, and Haiti. For 65% MDA coverage, the lower threshold is not cost-effective due to additional MDA rounds, although it increases the probability of local elimination. Valuing the benefits of elimination to align with the GPELF goals, we find that a willingness to pay per capita government expenditure of approximately $1000–$4000 for 1% increase in the probability of local elimination would be required to make a lower threshold cost-effective. Conclusions Lower Ag thresholds for stopping MDAs generally mean a higher probability of local elimination, reducing long-term costs and health impacts. However, they may also lead to an increased number of MDA rounds required to reach the lower threshold and, therefore, increased short-term costs. Collectively, our analyses highlight that lower target Ag thresholds have the potential to assist programs in achieving lymphatic filariasis goals.

中文翻译：

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降低抗原流行率目标阈值以停止和重新启动消除淋巴丝虫病的大规模药物管理：坦桑尼亚、印度和海地基于模型的成本效益模拟

背景 全球消除淋巴丝虫病计划 (GPELF) 旨在通过大规模药物管理 (MDA) 降低和维持感染水平，但有证据表明，在以库蚊为主要传播媒介的地区，MDA 后传播仍在继续，这表明更多在这些情况下，MDA 决策需要严格的标准。方法 我们使用传播模型来研究 MDA 决策的较低患病率阈值（<1% 抗原血症 [Ag] 患病率与 <2% Ag 患病率相比）将如何影响局部消除的可能性、健康结果、 MDA 轮次，包括重新启动以及与 MDA 相关的计划成本以及不同场景的调查。为了确定切换到较低门槛的成本效益，我们模拟了印度（446.07 美元）、坦桑尼亚（389.83 美元）、印度（446.07 美元）、坦桑尼亚（389.83 美元）、和海地（219.84 美元）。结果我们的结果表明，在 Ag 阈值较低的情况下，有一小部分模拟需要额外的轮数才能达到目标，但这也减少了程序后期重新启动 MDA 的需要。对于 80% 的覆盖率，对于印度、坦桑尼亚和海地的所有基线患病率来说，较低的阈值是具有成本效益的。对于 65% MDA 覆盖率，较低的阈值虽然增加了局部淘汰的概率，但由于需要额外的 MDA 轮次，因此并不具有成本效益。评估消除的好处以与 GPELF 目标保持一致，我们发现，为了使较低的门槛具有成本效益，需要愿意支付人均政府支出约 1000 至 4000 美元，才能使当地消除的可能性增加 1%。结论 停止 MDA 的 Ag 阈值越低，通常意味着局部消除的可能性越高，从而降低长期成本和健康影响。然而，它们也可能导致达到较低阈值所需的 MDA 轮数增加，从而增加短期成本。总的来说，我们的分析强调，较低的目标银阈值有可能帮助项目实现淋巴丝虫病目标。