Cost-effectiveness of meglumine antimoniate versus miltefosine caregiver DOT for the treatment of pediatric cutaneous leishmaniasis

Abstract

BackgroundOral miltefosine has been shown to be non-inferior to first-line, injectable meglumine antimoniate (MA) for the treatment of cutaneous leishmaniasis (CL) in children. Miltefosine may be administered via in-home caregiver Directly Observed Therapy (cDOT), while patients must travel to clinics to receive MA. We performed a cost-effectiveness analysis comparing miltefosine by cDOT versus MA for pediatric CL in southwest Colombia.Methodology/Principle findingsWe developed a Monte Carlo model comparing the cost-per-cure of miltefosine by cDOT compared to MA from patient, government payer, and societal perspectives (societal = sum of patient and government payer perspective costs). Drug effectiveness and adverse events were estimated from clinical trials. Healthcare utilization and costs of travel were obtained from surveys of providers and published sources. The primary outcome was cost-per-cure reported in 2015 USD. Treatment efficacy, costs, and adherence were varied in sensitivity analysis to assess robustness of results. Treatment with miltefosine resulted in substantially lower cost-per-cure from a societal and patient perspective, and slightly higher cost-per-cure from a government payer perspective compared to MA. Mean societal cost-per-cure were $531 (SD±$239) for MA and $188 (SD±$100) for miltefosine, a mean cost-per-cure difference of +$343. Mean cost-per-cure from a patient perspective were $442 (SD ±$233) for MA and $30 (SD±$16) for miltefosine, a mean difference of +$412. Mean cost-per-cure from a government perspective were $89 (SD±$55) for MA and $158 (SD±$98) for miltefosine, with a mean difference of -$69. Results were robust across a variety of assumptions in univariate and multi-way analysis.Conclusions/SignificanceTreatment of pediatric cutaneous leishmaniasis with miltefosine via cDOT is cost saving from patient and societal perspectives, and moderately more costly from the government payer perspective compared to treatment with MA. Results were robust over a range of sensitivity analyses. Lower drug price for miltefosine could result in cost saving from a government perspective.

“Cheaper and better”: Societal cost savings and budget impact of changing from systemic to intralesional pentavalent antimonials as the first-line treatment for cutaneous leishmaniasis in Bolivia

“…One study from Afghanistan assessed the cost effectiveness of SPA in terms of Disability Adjusted Life Years (DALY) averted, and concluded that using SPA to treat CL was not cost effective, using thresholds based on Gross Domestic Product from WHO-CHOICE [61]. A study conducted in Colombia found that in paediatric patients, miltefosine was slightly more expensive than SPA from a government payer perspective but substantially less expensive from the societal perspective due to savings related to the costs of food, lodging, transportation and productivity loss [62]. Similar results were found in our study where the highest savings using ILPA were related to reductions in the costs of meals, transportation and productivity loss.…”

Advanced case of PKDL due to delayed treatment: A rare case report

“…In corroboration with the previous studies, an elevated level of CD8 T cell at pre-treatment level is thought be involved in the highly ulcerated skin. Miltefosine is currently being used as anti-parasitic oral drug for treating PKDL which can easily accessible and safe to use [11,12]. Previous study also demonstrated the treatment with miltefosine for 12 weeks (50 mg twice per day) has a cure rate of 93% (per protocol [PP] analysis) [13].…”

Eligibility for Local Therapies in Adolescents and Adults with Cutaneous Leishmaniasis from Southwestern Colombia: A Cross-Sectional Study

“…Although few data are available for CL, health economic analyses show that systemic therapies generate a considerable economic burden for patients, health system and society. 19 In this context, the use of local therapies for around half of our population would alleviate the costs associated with the daily administration of treatment in health institutions and those represented by attention of adverse reactions. 20,21 Implementation of local therapies could also have an added benefit for populations with contraindications to systemic therapy, which needs to be evaluated 12 and could facilitate access to treatment, especially in rural areas, by decreasing the number of contacts with the health-care facilities.…”