02978nas a2200505   4500000000100000008004100001653001600042653001900058653002400077653001600101653000900117653001500126653001100141653001600152653001100168653002800179653003300207653002100240653001000261653001200271653002200283653000900305653001100314653001000325653001500335100001400350700001200364700001200376700001400388700001700402700001400419700001100433700001100444700001700455700001200472700001400484700001200498700001400510245010000524856007700624300001000701490000600711520174100717022001402458       2013                            d10aYoung Adult10aonchocerciasis10aModels, Statistical10aMiddle Aged10aMale10aIvermectin10aHumans10aFilaricides10aFemale10aCosts and Cost Analysis10aCommunicable Disease Control10aChild, Preschool10aChild10aAnimals10aAged, 80 and over10aAged10aAfrica10aAdult10aAdolescent1 aCoffeng L1 aStolk W1 aZoure H1 aVeerman L1 aAgblewonu KB1 aMurdoch M1 aNoma M1 aFobi G1 aRichardus JH1 aBundy D1 aHabbema D1 aVlas SJ1 aAmazigo U00aAfrican programme for onchocerciasis control 1995-2015: model-estimated health impact and cost.  uhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3561133/pdf/pntd.0002032.pdf  ae20320 v73 a<p><strong>BACKGROUND: </strong>Onchocerciasis causes a considerable disease burden in Africa, mainly through skin and eye disease. Since 1995, the African Programme for Onchocerciasis Control (APOC) has coordinated annual mass treatment with ivermectin in 16 countries. In this study, we estimate the health impact of APOC and the associated costs from a program perspective up to 2010 and provide expected trends up to 2015.</p>

<p><strong>METHODS AND FINDINGS: </strong>With data on pre-control prevalence of infection and population coverage of mass treatment, we simulated trends in infection, blindness, visual impairment, and severe itch using the micro-simulation model ONCHOSIM, and estimated disability-adjusted life years (DALYs) lost due to onchocerciasis. We assessed financial costs for APOC, beneficiary governments, and non-governmental development organizations, excluding cost of donated drugs. We estimated that between 1995 and 2010, mass treatment with ivermectin averted 8.2 million DALYs due to onchocerciasis in APOC areas, at a nominal cost of about US$257 million. We expect that APOC will avert another 9.2 million DALYs between 2011 and 2015, at a nominal cost of US$221 million.</p>

<p><strong>CONCLUSIONS: </strong>Our simulations suggest that APOC has had a remarkable impact on population health in Africa between 1995 and 2010. This health impact is predicted to double during the subsequent five years of the program, through to 2015. APOC is a highly cost-effective public health program. Given the anticipated elimination of onchocerciasis from some APOC areas, we expect even more health gains and a more favorable cost-effectiveness of mass treatment with ivermectin in the near future.</p>
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