Health Economics - Mass Scale-up Theme 3 (MST3)


The Health Economics theme assesses the efficiency, fairness and value-for-money of NTD programmes by conducting household-level micro-economic surveys.

To assess efficiency and equity impact of complementary approaches in NTD control. Policy-relevant evidence on value-for-money in terms of the efficiency and equity impact of the integrated approaches will be collected in all four countries through:

1) Observational economic evaluations of integrated programmes and

2) Household-level micro-economic population case-control surveys to measure equity impact.

Country-pooled cluster-level analysis will take place and generalizable enhancing and limiting factors identified in qualitative and quantitative ways using mixed methods. The economic evaluations, in a before-after design, are cost-effectiveness analysis and will measure the overall societal cost of combined NTDs, including all related health care costs at district and national level, all related direct and indirect household costs, and related loss of productivity cost, both at baseline and in a follow-up in areas where selected integrated and/or complementary NTD programmes are implemented.

COUNTDOWN - Health Economics Questions

Health Equity Analysis

- Does poverty make individuals more vulnerable to NTDs?

- Are NTDs more likely to make individuals poor?

- What other factors make individuals vulnerable to NTDs?

- How do NTDs affect households?


Cost-Effectiveness Analysis and Health Economic Modelling:

- Are the proposed COUNTDOWN interventions cost-effective?

- What are the scale-up option available if the goal is to achieve the 2020 London Declaration?

  •      Eliminate Lymphatic Filariasis and blinding Trachoma
  •      Control Onchocerciasis, Schistosomiasis and Soil-Transmitted Helminths

The surveys allow computation of poverty indices for equity in health status, programme access, and for distribution of out-of-pocket payments and other financial resources such as donor funding. The two rounds will provide the data to design, (re-)test, and validate NTD poverty-indices, combining data on coverage of NTD burden and household socio-economic status. The comparative economic evaluations are conducted from the societal and governmental perspective.

Both the evaluations and the surveys use standard statistical, clinometric, and econometric techniques to estimate the efficiency and equity impact of selected (combinations of) interventions as well as possible efficiency-equity trade-offs.

Outcomes are the change in disease burden including mental health status by poverty status in terms of number of covered persons that are NTD-protected and combined total disability-adjusted life years (DALYs). The detailed programme intervention cost will be estimated, and the overall changes in cost and cost-offsets to society, allowing for identification of economies-of-scale and up-scaling scenarios.