@article{01HMMHXM1T47718M14GVDZE25R,
  abstract     = {{Background Soil-transmitted helminth (STH) control programs currently lack evidence-based recommendations for cost-efficient survey designs for monitoring and evaluation. Here, we present a framework to provide evidence-based recommendations, using a case study of therapeutic drug efficacy monitoring based on the examination of helminth eggs in stool.

Methods We performed an in-depth analysis of the operational costs to process one stool sample for three diagnostic methods (Kato-Katz, Mini-FLOTAC and FECPAK(G2)). Next, we performed simulations to determine the probability of detecting a truly reduced therapeutic efficacy for different scenarios of STH species (Ascaris lumbricoides, Trichuris trichiura and hookworms), pre-treatment infection levels, survey design (screen and select (SS); screen, select and retest (SSR) and no selection (NS)) and number of subjects enrolled (100-5,000). Finally, we integrated the outcome of the cost assessment into the simulation study to estimate the total survey costs and determined the most cost-efficient survey design.

Principal findings Kato-Katz allowed for both the highest sample throughput and the lowest cost per test, while FECPAK(G2) required both the most laboratory time and was the most expensive. Counting of eggs accounted for 23% (FECPAK(G2)) or =80% (Kato-Katz and Mini-FLOTAC) of the total time-to-result. NS survey designs in combination with Kato-Katz were the most cost-efficient to assess therapeutic drug efficacy in all scenarios of STH species and endemicity.

Conclusions/significance We confirm that Kato-Katz is the fecal egg counting method of choice for monitoring therapeutic drug efficacy, but that the survey design currently recommended by WHO (SS) should be updated. Our generic framework, which captures laboratory time and material costs, can be used to further support cost-efficient choices for other important surveys informing STH control programs. In addition, it can be used to explore the value of alternative diagnostic techniques, like automated egg counting, which may further reduce operational costs.}},
  articleno    = {{e0011071}},
  author       = {{Coffeng, Luc E and Vlaminck, Johnny and Cools, Piet and Denwood, Matthew and Albonico, Marco and Ame, Shaali M and Ayana, Mio and Dana, Daniel and Cringoli, Giuseppe and de Vlas, Sake J and Fenwick, Alan and French, Michael and Kazienga, Adama and Keiser, Jennifer and Knopp, Stefanie and Leta, Gemechu and Matoso, Leonardo F and Maurelli, Maria P and Montresor, Antonio and Mirams, Greg and Mekonnen, Zeleke and Corrêa-Oliveira, Rodrigo and Pinto, Simone A and Rinaldi, Laura and Sayasone, Somphou and Steinmann, Peter and Thomas, Eurion and Vercruysse, Jozef and Levecke, Bruno}},
  issn         = {{1935-2727}},
  journal      = {{PLOS NEGLECTED TROPICAL DISEASES}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{23}},
  title        = {{A general framework to support cost-efficient fecal egg count methods and study design choices for large-scale STH deworming programs-monitoring of therapeutic drug efficacy as a case study}},
  url          = {{http://doi.org/10.1371/journal.pntd.0011071}},
  volume       = {{17}},
  year         = {{2023}},
}

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