A new scoping review published in PLOS Neglected Tropical Diseases maps the available evidence on the cost-effectiveness of soil-transmitted helminthiasis (STH) control programs, concluding that community-wide and integrated mass drug administration (MDA) strategies consistently outperform school-only approaches in high-prevalence settings.

The study, titled Cost-effectiveness of soil-transmitted helminthiasis intervention programmes: A scoping review and conducted as part of the STOP2030 project, with funding from Global Health EDCTP3 and the Swiss Government, reviewed 22 studies published between 1993 and 2025. Researchers from Kenya Medical Research Institute (KEMRI), Bridges to Development, Liconsa Labs and Mundo Sano took part in the scoping review.

STH infections affect over 1.5 billion people worldwide, causing anemia, malnutrition, impaired growth, and cognitive deficits, particularly among school-age children and women of reproductive age. While MDA with albendazole or mebendazole has been the cornerstone of control efforts, high reinfection rates in areas lacking clean water and sanitation have driven interest in more comprehensive approaches.

The review found that school-based delivery costs range from $0.03 to $0.76 per child, whereas community-wide programs cost between $0.27 and $1.74 per person. However, community-wide strategies proved more cost-effective in high-prevalence areas, with costs of $28 to $198 per disability-adjusted life year (DALY) averted. Integrated platforms, delivering multiple antiparasitic drugs in a single campaign, showed the highest economic returns, primarily due to shared delivery platforms and reduced operational costs.

The fixed-dose combination (FDC) of ivermectin and albendazole, developed by Liconsa (Insud Pharma) and advanced through the STOP2030 consortium, has demonstrated superior efficacy against all WHO-targeted STH species with comparable safety to single-dose albendazole. The FDC received its first national regulatory approval from Ghana’s FDA in 2025 and a positive scientific opinion from the European Medicines Agency under the EU-M4All programme.

The review also identifies critical evidence gaps: few studies include preschool-aged children, none include children under two years of age, and limited research assesses the long-term cost-effectiveness of combining MDA with water, sanitation, and hygiene (WASH) interventions. Additionally, the evidence base is heavily concentrated in sub-Saharan Africa, with scarce data from Latin America, the Caribbean, and the Western Pacific.