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Treatment for human visceral leishmaniasis: a cost‐effectiveness analysis for Brazil
Author(s) -
Carvalho Isis Polianna Silva Ferreira,
Peixoto Henry Maia,
Romero Gustavo Adolfo Sierra,
Oliveira Maria Regina Fernandes
Publication year - 2019
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 - 10.1111/tmi.13284
Subject(s) - meglumine antimoniate , medicine , cost effectiveness , surgery , intensive care medicine , leishmaniasis , visceral leishmaniasis , immunology , risk analysis (engineering)
Objective To estimate the cost‐effectiveness of strategies for the treatment of VL in Brazil. Methods Cost‐effectiveness study comparing three therapeutic options: meglumine antimoniate ( MA ), liposomal amphotericin B ( LAMB ) and a combination of LAMB plus MA ( LAMB plus MA ), from public health system and societal perspectives. An analytical decision‐making model was used to compare strategies for the following outcomes: early therapeutic failure avoided at 30 days, days of hospitalisation avoided and VL cure at 180 days. The efficacy and safety parameters of the drugs came from a randomised, open‐label trial and the cost data came from a cost‐of‐illness study, both carried out in Brazil. Results For all outcomes analysed, the LAMB strategy was more effective. The MA strategy was inferior to the LAMB plus MA strategy for the outcomes early therapeutic failure avoided and cure. When only LAMB and MA were compared from a societal perspective, a cost of US$ 278.56 was estimated for each additional early therapeutic failure avoided, a cost of US$ 26.88 for each additional day of hospitalisation avoided and a cost of US $ 89.88 for each additional case of cured VL , for the LAMB strategy vs . MA . Conclusion In Brazil, the LAMB strategy proved to be cost‐effective for treating VL , considering a GDP per capita as the willingness‐to‐pay threshold, for all of the outcomes analysed in comparison to MA .