Cost-Effectiveness of Triple Versus Dual-Drug Therapy for Elimination of Lymphatic Filariasis in India.

OBJECTIVES

Mass Drug Administration programs are crucial for eliminating lymphatic filariasis (LF) in India, where it remains a significant public health challenge. Shifting from the existing dual-drug regimen (diethylcarbamazine, albendazole [DA]) to a triple-drug regimen (ivermectin, diethylcarbamazine, and albendazole [IDA]) aims to accelerate LF elimination. This study aims to evaluate the cost-effectiveness of the IDA compared with the DA, providing insights for policy and resource allocation in LF elimination.

METHODS

We conducted a cost-effectiveness analysis to compare the health system costs and disability-adjusted life-years (DALYs) averted between IDA and DA for a population of 100 000 individuals. Data on costs and DALYs were obtained from secondary literature. The incremental cost-effectiveness ratio and net monetary benefit were calculated, utilizing India's gross domestic product per capita (US$ 2424) as the cost-effectiveness threshold. Sensitivity and budget impact analyses were performed.

RESULTS

The cost-effectiveness analysis revealed that IDA incurred an incremental ₹cost of US$ 578 (₹48 000) and averted 34 additional DALYs compared with DA, resulting in an incremental cost-effectiveness ratio of US$ 17 (₹1413) per DALY averted. The incremental net monetary benefit was US$ 81 726 (₹6 783 320). At the given cost-effectiveness threshold, IDA has a 95% probability of being cost-effective. Adopting IDA over DA would also yield budgetary savings of US$ 66.92 million (₹5554 million), reducing overall costs by 46%.

CONCLUSION

We found that IDA is cost-effective, when compared with DA, offering better health outcomes and long-term cost savings. These findings support the adoption of IDA in Mass Drug Administration programs, promoting efficient resource use and advancing LF elimination goals by 2027.