Economic analysis of the impact of overseas and domestic treatment and screening alternatives for parasitic infections among U.S.-bound refugees from Sub-Saharan Africa, 2013-2022
- 1US Centers for Disease Control and Prevention
Abstract
U.S.-bound refugees from sub-Saharan Africa arrive from countries where parasitic infections are highly endemic (including hookworm, ascariasis, trichuriasis, strongyloidiasis, schistosomiasis, and malaria). These infections are rare in the United States and may be underdiagnosed or misdiagnosed. This evaluation examined costs and health outcomes of four alternatives: 1) "Overseas Presumptive Treatment", 2) "Domestic Screening and Treatment", 3) "Domestic Presumptive Treatment", and 4) "No Program" using decision trees terminating in Markov transition state models. The current program, "Overseas Presumptive Treatment", is the least expensive and most effective alternative with baseline parameter estimates. Relative to "No Program", the net cost per QALY gained for "Overseas Presumptive Treatment" has 95% uncertainty interval (UI) from cost-saving to $52,000, Domestic Screening and Treatment": 95% UI: 6,700−580,000, and "Domestic Presumptive Treatment": 95% UI 12,000−1.29 million. Even using conservative parameter assumptions, overseas presumptive treatment is cost-effective and reduces the burden of parasitic infections among sub-Saharan refugees.
Article Summary LineIn this analysis, we estimated the costs and health outcomes of CDCs presumptive treatment program for parasitic diseases for U.S.-bound refugees from sub-Saharan Africa and compared these estimates to three hypothetical alternatives.
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BibTeX
@misc{maskery2026economic,
title = {{Economic analysis of the impact of overseas and domestic treatment and screening alternatives for parasitic infections among U.S.-bound refugees from Sub-Saharan Africa, 2013-2022}},
author = {B. A Maskery and H. Joo and J. Park and M. Weinberg and T. Mitchell and A. Klosovsky and W. Stauffer},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.04.26358165},
url = {https://www.medrxiv.org/content/10.64898/2026.09.04.26358165v1},
note = {CC0},
}
RIS
TY - UNPB
TI - Economic analysis of the impact of overseas and domestic treatment and screening alternatives for parasitic infections among U.S.-bound refugees from Sub-Saharan Africa, 2013-2022
AU - B. A Maskery
AU - H. Joo
AU - J. Park
AU - M. Weinberg
AU - T. Mitchell
AU - A. Klosovsky
AU - W. Stauffer
PY - 2026
DA - 2026/09/04
PB - medRxiv
DO - 10.64898/2026.09.04.26358165
UR - https://www.medrxiv.org/content/10.64898/2026.09.04.26358165v1
AB - U.S.-bound refugees from sub-Saharan Africa arrive from countries where parasitic infections are highly endemic (including hookworm, ascariasis, trichuriasis, strongyloidiasis, schistosomiasis, and malaria). These infections are rare in the United States and may be underdiagnosed or misdiagnosed. This evaluation examined costs and health outcomes of four alternatives: 1) "Overseas Presumptive Treatment", 2) "Domestic Screening and Treatment", 3) "Domestic Presumptive Treatment", and 4) "No Program" using decision trees terminating in Markov transition state models. The current program, "Overseas Presumptive Treatment", is the least expensive and most effective alternative with baseline parameter estimates. Relative to "No Program", the net cost per QALY gained for "Overseas Presumptive Treatment" has 95% uncertainty interval (UI) from cost-saving to $52,000, Domestic Screening and Treatment": 95% UI: 6,700−580,000, and "Domestic Presumptive Treatment": 95% UI 12,000−1.29 million. Even using conservative parameter assumptions, overseas presumptive treatment is cost-effective and reduces the burden of parasitic infections among sub-Saharan refugees. Article Summary LineIn this analysis, we estimated the costs and health outcomes of CDCs presumptive treatment program for parasitic diseases for U.S.-bound refugees from sub-Saharan Africa and compared these estimates to three hypothetical alternatives.
ER -