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How better drugs could change kala‐azar control. Lessons from a cost‐effectiveness analysis
Author(s) -
Boelaert M.,
Le Ray D.,
Van der Stuyft P.
Publication year - 2002
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1046/j.1365-3156.2002.00959.x
Subject(s) - medicine , intensive care medicine , visceral leishmaniasis , regimen , drug , leishmaniasis , surgery , pharmacology , immunology
Summary Conditional on correct diagnosis and treatment, current drug regimens for visceral leishmaniasis (VL) will only prevent about 90% of deaths. Furthermore, the cost of pentavalent antimonials, the long duration of the regimen and its parenteral administration are major obstacles for patients. Poor patient compliance and the use of counterfeit drugs contribute to therapeutic failure, amplification of the reservoir and the appearance of drug resistance. We assessed the impact of potential improvements in chemotherapy on the cost‐effectiveness of VL test‐treatment strategies. Competing test‐treatment strategies were compared in a formal decision analysis – from the viewpoint of the clinician facing a VL suspect –, with avoided VL‐mortality and cost as outcomes of interest. Sensitivity analysis was done involving the following parameters: efficacy, toxicity and cost of treatment including patient care. When safer and more efficacious drugs are considered, they only result in a more cost‐effective strategy if the total cost of treatment falls below US$ 390 per patient. A serological test‐treatment strategy remains the optimal choice, also when better drugs become available.