Analytical tools for planning cost-effective surveillance in Gambiense sleeping sickness

The re-emergence of sleeping sickness as a major health problem in parts of Africa, combined with the new sources of financial support and provision of drugs means that an investigation of the cost-effectiveness of the different approaches is timely. There has been very little work done on the economics of controlling either form of sleeping sickness. This paper builds on work done for WHO by the authors on developing a framework for analysing the cost-effectiveness of different methods for surveillance in gambiense sleeping sickness. The framework has been used to build a spreadsheet which makes it possible to simulate the effects of controlling the disease at different prevalences, for example using mobile teams or various forms of fixed post surveillance and screening different proportions of the population in a year. Prices, control strategies, prevalence, sensitivity and specificity of tests are all variables which can be altered to suit different situations or investigate how different approaches perform. As new research is beginning to produce calculations of the burden of sleeping sickness, in terms of disability-adjusted life years (DALY) potentially averted by controlling the disease, it is possible to combine these DALY estimates with the analyses of cost-effectiveness undertaken in these exercises to look at the cost-utility of the work, both to compare different approaches and demonstrate that controlling sleeping sickness represents good value for money as an investment in health.