The health and economic burden of lymphatic filariasis prior to mass drug administration programmes

Background: The Global Programme to Eliminate Lymphatic Filariasis (GPELF) was launched in 2000 with the goal of eliminating LF as a public health problem by 2020. Despite considerable progress, around 60% is remaining with the deadline looming a year away. Consequently, there is a continued need for investment in both the mass drug administration (MDA) and morbidity management programmes, which this paper aims to demonstrate by estimating the health and economic burden of LF prior to MDA programmes starting in GPELF areas. Methods: A previously developed model was used to estimate the number of individuals infected and those with symptomatic disease, along with the attributable number of disability-adjusted life years (DALYs). The economic burden was calculated by quantifying the costs incurred by the healthcare system in managing clinical cases, the patients’ out-of-pocket costs, and their productivity costs. Results: Prior to the MDA programme approximately 129 million were infected with LF, of which 43 million had clinical disease, corresponding to a DALY burden of 5.25 million. The average annual economic burden per chronic case was USD115, majority of which resulted from productivity costs. The total economic burden of LF was estimated at USD5.8 billion annually. Conclusion: These results demonstrate the magnitude of the LF burden and highlight the continued need to support the GPELF. Patients with clinical disease bore the majority of the economic burden but will not benefit much from the current MDA programme aimed at reducing transmission. This assessment further highlights the need to scale up morbidity management programmes.