Cost-effectiveness of soil-transmitted helminthiasis intervention programmes: A scoping review

Background: Soil-transmitted helminthiases (STH) infect over 1.5 billion people worldwide, causing serious health issues, especially among women of reproductive age and school-age children. Mass drug administration (MDA) using albendazole or mebendazole is the main method of control. However, high reinfection rates and limited integration with water, sanitation, and hygiene (WASH) and routine primary health care programs make the effectiveness of long-term control and elimination challenging. Methods: This scoping review aimed to systematically map and summarize cost-effectiveness evidence for STH control and elimination efforts. Following Arksey and O’Malley’s framework and Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines, we identified 22 studies published from 1993 to 2025 through PubMed and Google Scholar. Principal findings: Most studies focused on MDA intervention with school or community-based delivery platforms. School-based delivery costs ranged from $0.03 to $0.76 per child, and community-wide delivery costs ranged from $0.27 to $1.74 per individual. Community-wide programs were estimated to have greater impact and cost-effectiveness in high-prevalence areas, costing $28 to $198 per disability-adjusted life year averted. Programs that delivered multiple disease interventions (integrated programs) showed the highest economic returns, primarily due to shared delivery platforms and reduced operational costs. The main factors influencing cost-effectiveness included treatment coverage, baseline prevalence, and delivery costs. Evidence gaps for cost-effectiveness still exist for preschool-aged children and integration with WASH. Conclusion: This scoping review showed that context affects the cost-effectiveness of STH intervention programs. Community-wide and integrated MDA strategies offered more economic value than school-based delivery in areas with high prevalence. Author summary: Soil-transmitted helminthiases (STH) infect more than 1.5 billion people worldwide. These parasites cause anemia, poor nutrition, and impaired growth and learning, particularly among children and women of reproductive age (WRA). The main strategy to control STH has long been mass drug administration (MDA), where medicines such as albendazole and mebendazole are given regularly, usually in schools and communities. While this has had a significant impact on reducing the infections, reinfections are still high, especially in areas with poor water, sanitation, and hygiene (WASH) practices. In this study, 22 published studies on the cost-effectiveness of STH control programs were reviewed. School-based deworming programs cost less than community-wide approaches, but community-wide programs were more cost-effective and achieved a greater reduction in infections in areas with high prevalence. The study also identified important evidence gaps. Few studies included preschool-aged children (Pre-SAC) or WRA, and limited studies assessed the impact of combining MDA with WASH interventions. Overall, the cost-effectiveness of STH control varies by context. Community-wide MDA is more effective in high-prevalence areas, while school-based delivery may be sufficient in lower-prevalence settings depending on the dominant STH species and their transmission dynamics. The critical evidence gap between Pre-SAC and WRA underscores the need to explore the integration of MDA into routine primary care.