Economic Evaluation of Multi-Objective Schistosomiasis Control Through Systemic Causality: Theoretical Advances and Governance Implications

Schistosomiasis elimination is increasingly constrained less by the technical efficacy of single interventions than by systemic dynamics in coupled human–animal–environment settings, including nonlinear feedback, spatial heterogeneity, and cross-sectoral govern frictions. We conducted a systematic methodological review (search date: 1 January 2026) across PubMed, Web of Science, Scopus, EconLit, and CNKI to identify studies that (i) addressed schistosomiasis control, (ii) used explicit system-based, causal, or network-oriented analytical structures, and (iii) incorporated economic evaluation with multi-domain outcomes. We synthesized modeling architectures, economic methods, and approaches to trade-offs and uncertainty, and applied an evidence-informed systemic causality framework to assess decision-analytic adequacy. The literature grouped into three related strands: transmission and system dynamics models that capture feedback processes and rebound risks; economic evaluations dominated by cost-effectiveness analyses; and cross-sectoral or surveillance-oriented decision models optimizing implementation under resource constraints. Across strands, elimination-stage investments such as surveillance, environmental management, and coordination exhibit strong externalities and quasi-public-good properties that are systematically undervalued in single-sector, single-metric frameworks. We argue that decision-relevant evaluation should be reframed as a multi-objective resource allocation problem that integrates systemic modeling with economic valuation, explicitly addresses uncertainty, and applies multi-criteria decision analysis to support long-horizon, cross-sectoral decision-making.