Cost analysis of implementing community-based mass drug administration for schistosomiasis control among adult individuals using community drug distributors in Ukerewe district council, North-Western Tanzania.

backgroundSchistosomiasis is a significant public health challenge in sub-Saharan Africa, with Tanzania having the second-highest disease burden. While mass drug administration (MDA) with praziquantel is effective, high-risk groups including adults living in remote rural areas are often neglected. To achieve schistosomiasis elimination by 2030, it is important to expand mass treatment to groups left out of interventions. The five-year Ukerewe Schistosomiasis Control Program has expanded the MDA campaigns to include the adult population through a community-based MDA implemented by community drug distributors in remote islands. This study aimed to estimate the implementation costs of the first phase of the Ukerewe Schistosomiasis Control Program among the adult population residing on Ukerewe Island, Tanzania.

methodsA descriptive cross-sectional study was conducted from a provider's perspective, using a combination of activity-based costing and ingredients approaches to identify, quantify, and value all resources consumed in implementing the MDA. The analysis includes 30 villages and targeted 200,000 individuals. Secondary data were collected from financial records, inventory and transportation logs, and program budgets. Costs were categorized as capital if incurred on items that last more than a year or else as recurrent. Capital costs were annualized with a discount rate of 3% and annualization factor related to their useful life years (economic cost) or by straight-line depreciation method to estimate their economic and financial costs, respectively). Costs were collected in Tanzanian shillings (TZS) and adjusted to 2025 based on prevailing exchange rates from the Bank of Tanzania. The analysis was performed using an Excel spreadsheet (Microsoft Excel, Microsoft Corporation).

resultsFrom 2021 to 2025, the economic and financial costs of the program were estimated at USD 377,189 and USD 208,999 respectively. This translates into an average economic and financial costs of USD 1.2 and USD 0.7 per person treated. Nearly three-quarters of the economic cost (70%) was attributed to drug distribution and treatment, followed by training, sensitization, and monitoring activities. Recurrent costs, primarily for medicines and personnel, accounted for 97% of total cost. Cost projections through 2030 indicate that the total MDA costs will rise with population growth; however, the unit cost is expected to decline, signaling economies of scale and improved cost-efficiency.

conclusionThe Ukerewe MDA program provides strong evidence that large-scale, cost-efficient schistosomiasis treatment is feasible with robust planning. Future program efficiency can be further enhanced through improved supply chain systems, bulk procurement, and consideration of lower-cost praziquantel biosimilars, offering a scalable model for schistosomiasis control in other high-burden regions.