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While the health economic implications of disease elimination have been discussed before, the combination of uncertainty, cost effectiveness, and elimination has not been tackled before. We propose a modification to the net-benefit framework to explicitly consider the implications of switching from an optimal strategy, in terms of cost-per-burden averted, to a strategy with a higher likelihood of meeting the global target of elimination. The modification proposed yields a methodology to quantify the efficiency of elimination and to aid discussions among stakeholders with different objectives. We apply our method to strategies against human African trypanosomiasis in three settings, but this method is flexible enough that it can be applied directly to any simulation-based studies of disease elimination efforts. R code and simulation results data have been deposited in Open Science Framework (<https://OSF.IO/FH6CA>) ([49][1]). [1]: #ref-49

Monte carloTrypanosomiase humaine africaineErick miakaRon crumpLa monte carloMai ndombeGlobal fundProgramme national de lutteWorld health organizationMelinda gates foundationCentral africaDemocratic republicEvaluation frameworkDiscount ratesHuman africanAfrican trypanosomiasis