Comparison of an integrated versus stand-alone approach to post-validation surveillance for lymphatic filariasis in Niue: a micro-costing study, 2025.

Background: Lymphatic filariasis (LF) is a mosquito-borne parasitic disease which, in cases of chronic infection, may result in lymphoedema, elephantiasis, and hydrocele, imposing significant physical, social, and economic burdens. Global initiatives have reduced the prevalence of this condition, with Niue, a self-governing Pacific Island country, being validated as having eliminated LF as a public-health problem in 2016. To ensure transmission does not re-emerge, the World Health Organization recommends post-validation surveillance. As an integrated approach where LF-PVS is embedded within existing health programmes may reduce financial and labour costs and hence improve feasibility for resource constrained settings, we compare the costs of integrated LF-PVS in Niue with the counterfactual of stand-alone LF-PVS. Methods: We itemised activities and resources and assigned unit costs using a bottom-up micro-costing approach, drawing data from project budgets, accounting records, and staff reports. For the stand-alone scenario, we base LF survey inputs and activities on a recently implemented LF-PVS in a comparable context. For the integrated scenario, we embedded LF-PVS activities within a national STEPwise survey for non-communicable disease risk factors, with two research staff and one Department of Health officer responsible for implementation. All costs are reported in USD 2025 prices. Results: Total provider costs under the integrated scenario were USD 59 488 compared with USD 105 414 for the stand-alone. The integrated cost per participant tested was USD 59 compared to USD 105 for the stand-alone approach, representing a 44% reduction. The required Department of Health staff time was half in the integrated scenario, resulting in savings of approximately four weeks full-time equivalent staff time. Conclusions: This analysis provides evidence that programmatic integration of LF-PVS reduces cost to donors and lessens burden on public health staff. Future LF-PVS in the Pacific and elsewhere should consider integrating with routine health surveys to maximise operational efficiency.