Cost-effectiveness of end-game strategies against sleeping sickness across the Democratic Republic of Congo

Gambiense human African trypanosomiasis (gHAT) is marked for elimination of transmission (EoT) by 2030. We examined the cost-effectiveness (CE) of EoT in the Democratic Republic of Congo, which has the highest global gHAT burden. In 166 health zones (HZs), we modelled the transmission dynamics, health outcomes, and economic costs of six strategies during 2024-40, including the cessation of activities after case reporting reduces to zero. Uncertainty in CE was assessed within the net monetary framework, presented as the optimal strategies at a range of willingness-to-pay (WTP) values, denominated in costs per disability-adjusted life-year averted. Status quo strategies, CE strategies (WTP=$500), and strategies with a high probability of EoT by 2030 are predicted to yield EoT by 2030 in 117 HZs, 130 HZs, and 138 HZs respectively, at a cost by 2040 of $159M (82M–266M), $175M ($98M–$285M), $206M ($114M–$339M). A more lenient timeline of EoT by 2040 could lead to EoT in 153 HZs at a cost of $189M ($105M–$311M), leaving 13 HZs shy of the goal. Investing in EoT by 2030 is predicted to reduce gHAT deaths from 34,770 (14,113–71,118) with status quo strategies to 8,214 (3,284–18,507).