The limited economic resources available for health care in developing countries necessitates the involvement of cost analysis in the planning of any control intervention. A number of studies have undertaken cost-effectiveness analysis of schistosomiasis control, and the methodologies utilized in both cost and effectiveness evaluation are discussed. In attempting to relate cost to effectiveness, most studies have utilized static models expressing effectiveness in terms of coverage (drug delivery) or cure rate (infection prevalence reduction). These immediate output measures do not consider the long-term impact of control nor the effect on disease. An alternative approach is to use a model of the transmission dynamics of the parasite to permit evaluation of the long-term impact of control. An example of a population dynamic approach to cost-effectiveness analysis that can assess the impact of treatment on infection and disease due to the intestinal nematodes is presented to illustrate the potential of this approach in modeling the cost-effectiveness of schistosomiasis control.
Authors' addresses: H. L. Guyatt, Centre for the Epidemiology of Infectious Disease, University of Oxford, South Parks Road, Oxford OX 1 3PS, United Kingdom. M. Tanner, Department of Public Health and Epidemiology, Swiss Tropical Institute, Socinstrasse 57, Basel CH-4002, Switzerland.