Drug policy for visceral leishmaniasis: a cost-effectiveness analysis.

Hdl Handle:
http://hdl.handle.net/10144/17261
Title:
Drug policy for visceral leishmaniasis: a cost-effectiveness analysis.
Authors:
Vanlerberghe, V; Diap, G; Guerin, P J; Meheus, F; Gerstl, S; Van der Stuyft, P; Boelaert, M
Journal:
Tropical Medicine & International Health
Abstract:
OBJECTIVE: To facilitate the choice of the best visceral leishmaniasis (VL) treatment strategy for first-line health services in (VL)-endemic areas, we compared in a formal decision analysis the cost and the cost-effectiveness of the different available options. METHODS: We selected four drug regimens for VL on the basis of frequency of use, feasibility and reported efficacy studies. The point estimates and the range of plausible values of effectiveness and cost were retrieved from a literature review. A decision tree was constructed and the strategy minimizing the cost per death averted was selected. RESULTS: Treatment with amphotericin B deoxycholate was the most effective approach in the baseline analysis and averted 87.2% of all deaths attributable to VL. The least expensive and the most cost-effective treatment was the miltefosine regimen, and the most expensive and the least cost-effective was AmBisome treatment. The cost of drug and medical care are the main determinants of the cost-effectiveness ranking of the alternative schemes. Sensitivity analysis showed that antimonial was competitive with miltefosine in the low-resistance regions. CONCLUSION: In areas with >94% response rates to antimonials, generic sodium stibogluconate remains the most cost-effective option for VL treatment, mainly due to low drug cost. In other regions, miltefosine is the most cost-effective option of treatment, but its use as a first-line drug is limited by its teratogenicity and rapid resistance development. AmBisome in mono- or combination therapy is too expensive to compete in cost-effectiveness with the other regimens.
Affiliation:
Epidemiology and Disease Control Unit, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium. vvanlerberghe@itg.be
Issue Date:
Feb-2007
URI:
http://hdl.handle.net/10144/17261
DOI:
10.1111/j.1365-3156.2006.01782.x
PubMed ID:
17300636
Additional Links:
http://www.blackwell-synergy.com/loi/tmi
Language:
en
ISSN:
1360-2276
Appears in Collections:
Leishmaniasis/Kala Azar

Full metadata record

DC FieldValue Language
dc.contributor.authorVanlerberghe, V-
dc.contributor.authorDiap, G-
dc.contributor.authorGuerin, P J-
dc.contributor.authorMeheus, F-
dc.contributor.authorGerstl, S-
dc.contributor.authorVan der Stuyft, P-
dc.contributor.authorBoelaert, M-
dc.date.accessioned2008-01-31T15:37:26Z-
dc.date.available2008-01-31T15:37:26Z-
dc.date.issued2007-02-
dc.identifier.citationDrug policy for visceral leishmaniasis: a cost-effectiveness analysis. 2007, 12 (2):274-83 Trop. Med. Int. Healthen
dc.identifier.issn1360-2276-
dc.identifier.pmid17300636-
dc.identifier.doi10.1111/j.1365-3156.2006.01782.x-
dc.identifier.urihttp://hdl.handle.net/10144/17261-
dc.description.abstractOBJECTIVE: To facilitate the choice of the best visceral leishmaniasis (VL) treatment strategy for first-line health services in (VL)-endemic areas, we compared in a formal decision analysis the cost and the cost-effectiveness of the different available options. METHODS: We selected four drug regimens for VL on the basis of frequency of use, feasibility and reported efficacy studies. The point estimates and the range of plausible values of effectiveness and cost were retrieved from a literature review. A decision tree was constructed and the strategy minimizing the cost per death averted was selected. RESULTS: Treatment with amphotericin B deoxycholate was the most effective approach in the baseline analysis and averted 87.2% of all deaths attributable to VL. The least expensive and the most cost-effective treatment was the miltefosine regimen, and the most expensive and the least cost-effective was AmBisome treatment. The cost of drug and medical care are the main determinants of the cost-effectiveness ranking of the alternative schemes. Sensitivity analysis showed that antimonial was competitive with miltefosine in the low-resistance regions. CONCLUSION: In areas with >94% response rates to antimonials, generic sodium stibogluconate remains the most cost-effective option for VL treatment, mainly due to low drug cost. In other regions, miltefosine is the most cost-effective option of treatment, but its use as a first-line drug is limited by its teratogenicity and rapid resistance development. AmBisome in mono- or combination therapy is too expensive to compete in cost-effectiveness with the other regimens.en
dc.language.isoenen
dc.relation.urlhttp://www.blackwell-synergy.com/loi/tmi-
dc.rightsArchived on this site with the kind permission of Wiley-Blackwellen
dc.subject.meshAmphotericin Ben
dc.subject.meshAntimonyen
dc.subject.meshAntiprotozoal Agentsen
dc.subject.meshCost-Benefit Analysisen
dc.subject.meshDecision Treesen
dc.subject.meshDeoxycholic Aciden
dc.subject.meshDrug Combinationsen
dc.subject.meshEndemic Diseasesen
dc.subject.meshHealth Care Costsen
dc.subject.meshHumansen
dc.subject.meshLeishmaniasis, Visceralen
dc.subject.meshPhosphorylcholineen
dc.subject.meshTreatment Outcomeen
dc.titleDrug policy for visceral leishmaniasis: a cost-effectiveness analysis.en
dc.contributor.departmentEpidemiology and Disease Control Unit, Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium. vvanlerberghe@itg.been
dc.identifier.journalTropical Medicine & International Healthen

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