Health economic evaluation of strategies to eliminate *gambiense* human African trypanosomiasis in the Mandoul disease focus of Chad ======================= **Human African Trypanosomiasis Modeling and Economic Predictions for Policy** ([HATMEPP](https://go.warwick.ac.uk/hatmepp)) Administered by Marina Antillon, PhD. Collaborating centers: ___Zeeman Institute for Systems Biology and Infectious Disease Epidemiology Research (SBIDER)___ University of Warwick Coventry, UK ___Epidemiology and Public Health___ ___Swiss Tropical and Public Health (Swiss TPH) Institute___ (An affiliated institute of the University of Basel) Basel, Switzerland Contact: Marina Antillon marina.antillon@swisstph.ch. COPYRIGHT 2022, Swiss TPH and Warwick University --- @[toc](Contents) # Project Objective In the current study, we undertake an economic evaluation of four gHAT control and elimination strategies in Mandoul, Chad. We adopt a modelling framework in order to examine the interplay of epidemiological, economic and temporal factors in effective decision-making around gHAT strategies for elimination of transmission (EOT). We aim to answer the following questions - A retrospective cost-effectiveness analysis for the Mandoul focus of the intensified strategies that started in 2014 to understand the health economic implications if less ambitious strategies had been performed, as well as a sensitivity analysis to test if the decision would have been robust to earlier introduction of fexinidazole. - A prospective analysis then considers the health economic implications of what could be done against gHAT going forward from 2023 for Mandoul. The pre-print manuscript is found here: **CHANGE** //doi.org/10.1101/2020.08.25.20181982 The companion website is found here: https://hatmepp.warwick.ac.uk/MandoulCEA/v1 A guide on how to use the companion website is found [here](https://warwick.ac.uk/fac/cross_fac/zeeman_institute/new_research/combatting_disease/hat/hatmepp/gui/gui_user_guide_cost_evaluations_v1.2_en.pdf). --- # Overview of analysis The analysis is broadly defined in three parts, each of these parts is executed in various R code files: I. Projecting health outcomes under alternative strategies of gHAT control. II. Costing: for clinical activities as well as screening and prevention (vector control) activities under alternative strategies. III. Cost-effectiveness analysis of alternative strategies. This model takes the output of the dynamic (SIR-type) model developed and operated by the Warwick team and projects the clinical outcomes and the accompanying costs of treating patients. The overall flow of models is diagrammed below and provided in high resolution [here](https://osf.io/rxvdn):  ## Software considerations The tools for the economic model are coded in R. While we would highly recommend using the code within RStudio environment (in part because of it's features to manage the project with .RProj and renv) this is not strictly necessary and the benefits of renv are available from a classic R interface or a shell command line. Some of the results tables for the project are produced automatically within the code in the project via Rmarkdown (using knitr) and Latex. See the help links later in this document for more information. For detailed information, see: [Installation to-do list](https://osf.io/bjxwn/wiki/Installation%20to-do%20list/) (all free) ## Hardware considerations **Hardware needs:** A personal computer is sufficient. **Duration:** For reference, a single run of the code for all strategies in one place takes about 1-2 minutes in a MacBook Air (2020 model) with an Apple M1 chip and 16 GB of RAM. **Memory needed:** Intermediate simulations and graphs need about 600-700 MB of storage per health zone per scenario (the full analysis, including sensitivity analyses adds up to 3 sets of results). --- # Preparation [Installation to-do list](https://osf.io/bjxwn/wiki/Installation%20to-do%20list/) (all free) --- # How to run this analysis [Instructions to run the analysis](https://osf.io/bjxwn/wiki/Instructions%20to%20run%20analysis/) For reference, the file structure of this repository is described here: [file structure](https://osf.io/bjxwn/wiki/File%20structure%2C%20inputs%2C%20and%20outputs/) --- # Demo and sample results [Demo and sample results](https://osf.io/bjxwn/wiki/Demo%20and%20expected%20results/) --- # Troubleshooting [Troubleshooting](https://osf.io/bjxwn/wiki/Troubleshooting/)