-->PNTD-D-25-01829

Cost-effectiveness of soil-transmitted helminthiasis intervention programmes: A scoping review

PLOS Neglected Tropical Diseases

Dear Dr. Okoyo,

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Kind regards,

Luis Marcos, MD, MPH, FIDSA

Guest Editor

PLOS Neglected Tropical Diseases

Krystyna Cwiklinski

Section Editor

PLOS Neglected Tropical Diseases

Shaden Kamhawi

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-4304-636XX

Paul Brindley

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-1765-0002

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Reviewers' Comments:

Reviewer's Responses to Questions

Key Review Criteria Required for Acceptance?

As you describe the new analyses required for acceptance, please consider the following:

Methods

-Are the objectives of the study clearly articulated with a clear testable hypothesis stated?

-Is the study design appropriate to address the stated objectives?

-Is the population clearly described and appropriate for the hypothesis being tested?

-Is the sample size sufficient to ensure adequate power to address the hypothesis being tested?

-Were correct statistical analysis used to support conclusions?

-Are there concerns about ethical or regulatory requirements being met?

Reviewer #1: Overall, this is a well written and clear paper. The results are compelling, despite the acknowledged limitations. My main concern or question regarding the methodology is whether the studies that were included based their cost-effectiveness analyses on actual (i.e., measured) costs/benefits or on assumed or estimated ones? Is there a way for the authors to ascertain this for each study and to add it to the paper? For example, the single Brazil study seems to have included inputs from several other studies (even some done in Africa).

Minor:

1. Figure 1 describes records marked as ineligible by "automation tools" but these tools are not described in the Methods section. Please clarify.

Reviewer #2: the objective is clear with correct statistical analysis

Reviewer #3: The research question must be well-defined and aligned with the objectives. There is no consistency between the conclusion and the questions posed at the beginning.

Although they chose a scoping review approach, when discussing the economic models used to evaluate these studies, these models are not ultimately considered or mentioned.

The title does not accurately reflect the paper's actual purpose, and, most importantly, it fails to specify the geographical areas studied. I would suggest narrowing the scope to Sub-Saharan Africa.

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Results

-Does the analysis presented match the analysis plan?

-Are the results clearly and completely presented?

-Are the figures (Tables, Images) of sufficient quality for clarity?

Reviewer #1: 1. Line 262: please clarify that the "hookworm vaccine" is a hypothetical one, since there currently is no approved vaccine for this STH.

2. Table 2 lists the year of publication for each study, but that doesn't necessarily reflect the time period when the data were collected, since publication could have occurred years later. Would it be possible to include the dates that the studies were conducted or during which the data were collected?

Reviewer #2: analysis presented match the analysis plan

Reviewer #3: The results should be aligned with the studies. Table 1 should be improved, as it is currently redundant, and I would recommend eliminating the third column.

The map presented should have two parts: zones showing areas according to prevalence (high, medium, or low), and, either on the same or a separate map, the number of studies in choropleth maps. If the studies only considered English-language literature, I would remove the data concerning Latin America from the study to avoid drawing erroneous conclusions.

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Conclusions

-Are the conclusions supported by the data presented?

-Are the limitations of analysis clearly described?

-Do the authors discuss how these data can be helpful to advance our understanding of the topic under study?

-Is public health relevance addressed?

Reviewer #1: Overall, the conclusions appear to be supported by the data presented. Limitations are clearly stated.

Reviewer #2: the conclusion supported by data presented, the authors discuss how data can help understanding of strategies for the control of STD.

Reviewer #3: The study draws conclusions based on unclear information, such as defining that population-level interventions are more cost-effective than school-level interventions, when Table 1 only identifies two or three studies with those characteristics.

The limitations do not mention that the cost-effectiveness analyses that should have been used were not performed, and I believe this should be clearly stated in the limitations.

As the authors themselves mention, there are significant biases in the collection and analysis of the data. I suggest improving the analysis, the formulation of the research question, and ensuring consistency throughout the article.

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Editorial and Data Presentation Modifications?

Use this section for editorial suggestions as well as relatively minor modifications of existing data that would enhance clarity. If the only modifications needed are minor and/or editorial, you may wish to recommend “Minor Revision” or “Accept”.

Reviewer #1: 1. Lines 91-93: how does coformulation of albendazole and ivermectin in a fixed-dose combination provide evidence of effectiveness? I think that what the authors mean to say is that recent evidence from a Phase 2/3 trial (published in TLID) showed improved efficacy of the FDC vs single-dose ALB against T. trichiura. However, the sentence as currently worded does not state this and should be revised for clarity.

2. Line 166: should this be "ratio" instead of "ration" (ICER definition)?

Reviewer #2: These data could have been very useful in general. Because of the limitation to English litterature its sound that in area where STD and others parasite like Loa loa co exist. strategies may be different. I will suggest that the authors expand discussion on this particular situation ( IVM= ivermetin, may be use with caution in loiasis endemic countries ....) where economic benefits of combined ALB/IVM needs further studies.

Reviewer #3: (No Response)

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Summary and General Comments

Use this section to provide overall comments, discuss strengths/weaknesses of the study, novelty, significance, general execution and scholarship. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. If requesting major revision, please articulate the new experiments that are needed.

Reviewer #1: (No Response)

Reviewer #2: This study map the area covered by mass drug administration for STD control in the world. Its show economic value of community based control over school chidren based control. its demonstrate that community based control is more economical than school children based strategy. We suggest to the authors to expand their discussion in area where STD co exist whit filaria Loa loa

Reviewer #3: I believe that while the article addresses an important topic such as the cost-effectiveness of programs, it fails to integrate the necessary methods for conducting such analyses through a systematic review. I suggest that the title be revised, clearly stating that it is merely a description and not an analysis, as is the conclusion reached.

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Reviewer #2: No

Reviewer #3: No

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Submitted filename: PNTD-D-25-01829.docx

Dear Dr Okoyo,

We are pleased to inform you that your manuscript 'Cost-effectiveness of soil-transmitted helminthiasis intervention programmes: A scoping review' has been provisionally accepted for publication in PLOS Neglected Tropical Diseases.

Before your manuscript can be formally accepted you will need to complete some formatting changes, which you will receive in a follow up email. A member of our team will be in touch with a set of requests.

Please note that your manuscript will not be scheduled for publication until you have made the required changes, so a swift response is appreciated.

IMPORTANT: The editorial review process is now complete. PLOS will only permit corrections to spelling, formatting or significant scientific errors from this point onwards. Requests for major changes, or any which affect the scientific understanding of your work, will cause delays to the publication date of your manuscript.

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Thank you again for supporting Open Access publishing; we are looking forward to publishing your work in PLOS Neglected Tropical Diseases.

Best regards,

Luis Marcos, MD, MPH, FIDSA

Guest Editor

PLOS Neglected Tropical Diseases

Krystyna Cwiklinski

Section Editor

PLOS Neglected Tropical Diseases

Shaden Kamhawi

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-4304-636XX

Paul Brindley

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-1765-0002

***********************************************************

Authors have addressed properly all feedback provided by reviewers. Article sounds now more scientifically correct.

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