Cost-effectiveness modelling to optimise active screening strategy for <i>gambiense</i> human African trypanosomiasis in the Democratic Republic of Congo

Abstract Gambiense human African trypanosomiasis (gHAT) has been brought under control recently with village-based active screening playing a major role in case reduction. In the eve of elimination, we investigate how to optimise active screening in villages in the Democratic Republic of Congo, such that the expenses of screening programmes can be efficiently allocated while continuing to avert morbidity and mortality. We implement a cost-effectiveness analysis using a stochastic gHAT infection model for a range of active screening strategies and we calculate the net monetary benefit (NMB) of each strategy. High-coverage active screening strategies, occurring approximately annually, attain the highest NMB. We find that, for strategies stopping after one to three years of zero case reporting, the expected cost-benefits are very similar and we highlight the current recommended strategy (three years before stopping) is likely cost-effective, in addition to providing valuable information on whether transmission has been interrupted.