Cost-effectiveness of end-game strategies against sleeping sickness across the Democratic Republic of Congo

Abstract

BACKGROUND: Gambiense human African trypanosomiasis (gHAT) is marked for elimination of transmission (EoT) by 2030. We examined the cost-effectiveness (CE) of EoT in the Democratic Republic of Congo, the country with the highest burden. METHODS: In 165 health zones (HZs), we modelled the transmission dynamics, health outcomes, and economic costs of six strategies during 2026-40, including cessation activities once reported cases reach zero. Uncertainty in CE was assessed within the net monetary framework, presenting optimal strategies across willingness-to-pay (WTP) values, in costs per disability-adjusted life-year averted. We assessed the optimal strategy for CE and EoT in each health zone separately, but present results by health zone, by coordination, and for the whole country. RESULTS: Status Quo strategies, CE strategies (WTP = $500), and strategies that maximise the probability of EoT by 2030 are predicted to yield EoT by 2030 in 118 HZs, 123 HZs, and 134 HZs respectively, at a cost by 2040 of $67.8M [95% PI: $36.7M-113M], $93.3M [95% PI: $51.6M-153M], $185M [95% PI: $111M-309M]. A more lenient timeline of EoT by 2040 would lead to EoT in 152 HZs at a cost of $158M [95% PI: $91.6-265M], leaving 13 HZs shy of the goal. Costs would have to be front-loaded; in 2026, while Status Quo strategies would cost $8.75M [95% PI: $7.01M-11.2M], elimination strategies would cost $27.0 [95% PI: $21.0M-35.2M]. Investing in EoT by 2030 is predicted to reduce 68% of gHAT deaths from 7979 [95% PI: 770-27,868] with Status Quo strategies to 2576 [95% PI: 255-9133]. CONCLUSIONS: Current tools could make considerable progress to maximise the probability of EoT by 2030, but novel tools could help in select health zones that are facing a low probability of EoT even with more ambitious strategies.

The authors' abstract, as published at the source. PLoS neglected tropical diseases, 2026 · DOI ↗