Cost-effectiveness of different strategies for screening and treatment of Strongyloides stercoralis in migrants from endemic countries to the European Union

Philip Erick Wikman-Jorgensen; Jara Llenas-Garcia; Jad Shedrawy; Joaquim Gascon; Jose Muñoz; Zeno Bisoffi; Ana Requena-Mendez

doi:10.1136/bmjgh-2020-002321

Cost-effectiveness of different strategies for screening and treatment of Strongyloides stercoralis in migrants from endemic countries to the European Union

BMJ Glob Health. 2020 May;5(5):e002321. doi: 10.1136/bmjgh-2020-002321.

Authors

Philip Erick Wikman-Jorgensen^{1

2}, Jara Llenas-Garcia^{3

4}, Jad Shedrawy⁵, Joaquim Gascon⁶, Jose Muñoz⁶, Zeno Bisoffi^{7

8}, Ana Requena-Mendez^{9

10}

Affiliations

¹ Medicina Interna, Hospital Universitari San Juan de Alicante, San Juan de Alicante, Alicante, Spain wikman.philip@gmail.com.
² Foundation for the Promotion of the Research in Healthcare and Biomedicine, Valencia, Spain.
³ Medicina Interna/Enfermedades Infecciosas, Hospital Vega Baja-FISABIO, San Bartolome-Orihuela, Alicante, Spain.
⁴ Clinical Medicine, Universidad Miguel Hernandez de Elche Facultad de Medicina, Sant Joan D'Alacant, Spain.
⁵ Public Health, Karolinska Institutet, Stockholm, Stockholm County, Sweden.
⁶ ISGlobal, Barcelona, Catalunya, Spain.
⁷ Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Veneto, Italy.
⁸ Diagnostics and Public Health, University of Verona, Verona, Veneto, Italy.
⁹ Instituto de Salud Global Barcelona, Barcelona, Spain.
¹⁰ Division of Infectious Diseases, Department of Medicine-Solna, Karolinska Institutet, Stockholm, Sweden.

Abstract

Background: The best strategy for controlling morbidity due to imported strongyloidiasis in migrants is unclear. We evaluate the cost-effectiveness of six possible interventions.

Methods: We developed a stochastic Markov chain model. The target population was adult migrants from endemic countries to the European Union; the time horizon, a lifetime and the perspective, that of the health system. Average and incremental cost-effectiveness ratios (ACER and ICER) were calculated as 2016 EUR/life-year gained (LYG). Health interventions compared were: base case (no programme), primary care-based presumptive treatment (PCPresTr), primary care-based serological screening and treatment (PCSerTr), hospital-based presumptive treatment (HospPresTr), hospital-based serological screening and treatment (HospSerTr), hospital-based presumptive treatment of immunosuppressed (HospPresTrim) and hospital-based serological screening and treatment of the immunosuppressed (HospSerTrim). The willingness to pay threshold (WTP) was €32 126.95/LYG.

Results: The base case model yielded a loss of 2 486 708.24 life-years and cost EUR 3 238 393. Other interventions showed the following: PCPresTr: 2 488 095.47 life-years (Δ1 387.23LYG), cost: EUR 8 194 563; ACER: EUR 3573/LYG; PCSerTr: 2 488 085.8 life-years (Δ1377.57LYG), cost: EUR 207 679 077, ACER: EUR 148 407/LYG; HospPresTr: 2 488 046.17 life-years (Δ1337.92LYG), cost: EUR 14 559 575; ACER: EUR 8462/LYG; HospSerTr: 2 488 024.33 life-years (Δ1316.08LYG); cost: EUR 207 734 073; ACER: EUR 155 382/LYG; HospPresTrim: 2 488 093.93 life-years, cost: EUR 1 105 483; ACER: EUR -1539/LYG (cost savings); HospSerTrim: 2 488 073.8 life-years (Δ1365.55LYG), cost: EUR 4 274 239; ACER: EUR 759/LYG. One-way and probabilistic sensitivity analyses were undertaken; HospPresTrim remained below WTP for all parameters' ranges and iterations.

Conclusion: Presumptively treating all immunosuppressed migrants from areas with endemic Strongyloides would generate cost savings to the health system.

Keywords: Strongyloides stercoralis infection; health economics; infections, diseases, disorders, injuries; public health; screening.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Animals
Cost-Benefit Analysis
European Union
Humans
Mass Screening
Strongyloides stercoralis*
Transients and Migrants*