A systematic review and quality appraisal of the economic evaluations of schistosomiasis interventions

Background: Schistosomiasis is a neglected tropical disease (NTD) that affects over 230 million people in low and middle-income countries (LMICs) and can lead to long-term debilitating health effects. It is associated with impoverishment and has been prioritised by the World Health Organization for prevention, control and elimination. This systematic review aimed to identify and evaluate existing economic evaluations of interventions to tackle schistosomiasis. Methodology: A comprehensive search strategy of four databases and additional hand-searching was employed on the 17th July 2020. The articles were screened and sorted using a two-stage classification system. Full economic evaluations published in English between 1st January 1998 and 17th July 2020 were included, and methodological quality was appraised using the international decision support initiative (iDSI), Phillips and Evers checklists. Results: Eighteen economic evaluations were identified, nine trial-based and nine model-based, with the majority focused on preventative chemotherapy. Schistosomiasis interventions were collectively found to be cost-effective, but the quantity and quality of studies were limited. The outcome measures and time-horizons utilised varied substantially making comparison difficult. The majority of papers failed to address equity and affordability. Conclusion: Several methodological issues were highlighted which might have implications for optimal decision-making. Future research is needed to ensure the standardisation of methods, in order to ensure that scarce healthcare resources are focused on the most cost-effective programmes to tackle schistosomiasis and other NTDs. Author summary: Schistosomiasis is a neglected tropical disease that has been prioritised by the World Health Organization (WHO) for prevention, control and elimination. Its long-term devastating health effects are widely documented, as are its significant impacts on vulnerable communities. There is a deficit of donor funding for many schistosomiasis-endemic countries, and this paucity of financing requires affected states to adopt schistosomiasis interventions that are the most cost-effective, in order to maximise health outcomes for their populations.