Economic evaluation of disease elimination: an extension to the net benefits framework and application to human African trypanosomiasis

Abstract: The net benefits framework has become a mainstay of the cost-effectiveness literature, guiding decision-makers to select among strategies in the presence of budget constraints and imperfect information. However, disease elimination programs are socially desirable but not always cost-effective. Therefore, analytical frameworks are necessary to consider the additional premium for reaching global goals that are beyond the cost-effective use of country resources. We propose a modification to the net benefits framework to consider the implications of switching from an optimal strategy (in terms of cost-per-burden-averted) to a strategy with a higher likelihood of meeting the global target (i.e. elimination of transmission by a specified date). Our expanded framework informs decisions under uncertainty, determines the share of funding necessary to align local and global priorities, enabling local partners to use their resources efficiently while cooperating to meet global health targets. We illustrate the advantages of our framework by considering the economic case of efforts to eliminate transmission by 2030 of gambiense human African trypanosomiasis (gHAT), a vector-borne parasitic disease in West and Central Africa.