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

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.