Short communication: The cost‐effectiveness of cutaneous leishmaniasis patient management during an epidemic in Chaparral, Colombia in 2004

Vega, Jorge; Sanchez, Boris Fernando; Montero, Luz Mery; Montaña, Rafael Augusto Rozo; Mahecha, Mercedes del Pilar; Dueñes, Bladimir; Baron, Angela; Reithinger, Richard

doi:10.1111/j.1365-3156.2007.01962.x

Cited by 18 publications

(16 citation statements)

References 10 publications

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“…Analyses have not found antimonial treatment of cutaneous leishmaniasis as cost-effective. While thermotherapy cost has not been included in these models, it is likely to be cost-effective in endemic areas [17],[24],[25]. Future research could assess whether thermotherapy treated areas showed persistent Leishmania organisms as seen after clinical healing post SSG; if not, then the implication of lessened risk of later reactivation but also the role of potentially lessened protection from reinfection might be better understood [26],[27].…”

Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial of Local Heat Therapy Versus Intravenous Sodium Stibogluconate for the Treatment of Cutaneous Leishmania major Infection

et al. 2010

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BackgroundCutaneous Leishmania major has affected many travelers including military personnel in Iraq and Afghanistan. Optimal treatment for this localized infection has not been defined, but interestingly the parasite is thermosensitive.Methodology/Principal FindingsParticipants with parasitologically confirmed L. major infection were randomized to receive intravenous sodium stibogluconate (SSG) 20mg/kg/day for ten doses or localized ThermoMed (TM) device heat treatment (applied at 50°C for 30 seconds) in one session. Those with facial lesions, infection with other species of Leishmania, or more than 20 lesions were excluded. Primary outcome was complete re-epithelialization or visual healing at two months without relapse over 12 months. Fifty-four/56 enrolled participants received intervention, 27 SSG and 27 TM. In an intent to treat analysis the per subject efficacy at two months with 12 months follow-up was 54% SSG and 48% TM (p = 0.78), and the per lesion efficacy was 59% SSG and 73% TM (p = 0.053). Reversible abdominal pain/pancreatitis, arthralgias, myalgias, headache, fatigue, mild cytopenias, and elevated transaminases were more commonly present in the SSG treated participants, whereas blistering, oozing, and erythema were more common in the TM arm.Conclusions/SignificanceSkin lesions due to L. major treated with heat delivered by the ThermoMed device healed at a similar rate and with less associated systemic toxicity than lesions treated with intravenous SSG.Clinical Trial RegistrationClinicalTrials.gov NCT 00884377

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Section: Discussionmentioning

confidence: 99%

A Randomized Controlled Trial of Local Heat Therapy Versus Intravenous Sodium Stibogluconate for the Treatment of Cutaneous Leishmania major Infection

et al. 2010

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“…A study of an outbreak in Colombia estimated costs at $345 per cure; with MA drug costs of 300% of the cost assumed in our analysis [36]. Government payer cost-per-cure for MA in Guatemala and Peru has been estimated at $280 and $300, respectively [37,38].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…For instance, a CL case could seek treatment and be cured, in which case the duration of their disease was shorter than those not cured by treatment; CL episodes were assumed to last one year or less[22]. Those recovering from CL had a risk of developing Leishmania strain-specific outcomes such as MCL (approx.…”

Section: Methodsmentioning

confidence: 99%

“…We conservatively assume that individuals were at risk of MCL and DCL up to 10 years after CL, although some report this duration to be up to 30 years. Although treatment costs can vary greatly by country, treatment costs that were used are comparable to direct medical costs per patient reported during the cutaneous leishmaniasis outbreak in Colombia[22] and reports from Brazil[54]. …”

Section: Limitationsmentioning

confidence: 99%

The potential economic value of a cutaneous leishmaniasis vaccine in seven endemic countries in the Americas

Bacon

Hotez

Kruchten

et al. 2013

Vaccine

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Cutaneous leishmaniasis (CL) and its associated complications, including mucocutaneous leishmaniasis (MCL) and diffuse CL (DCL) have emerged as important neglected tropical diseases in Latin America, especially in areas associated with human migration, conflict, and recent deforestation. Because of the limitations of current chemotherapeutic approaches to CL, MCL, and DCL, several prototype vaccines are in different states of product and clinical development. We constructed and utilized a Markov decision analytic computer model to evaluate the potential economic value of a preventative CL vaccine in seven countries in Latin America: Bolivia, Brazil, Colombia, Ecuador, Mexico, Peru, and Venezuela. The results indicated that even a vaccine with a relative short duration of protection and modest efficacy could be recommended for use in targeted locations, as it could prevent a substantial number of cases at low-cost and potentially even result in cost savings. If the population in the seven countries were vaccinated using a vaccine that provides at least 10 years of protection, an estimated 41,000-144,784 CL cases could be averted, each at a cost less than the cost of current recommended treatments. Further, even a vaccine providing as little as five years duration of protection with as little as 50% efficacy remains cost-effective compared with chemotherapy; additional scenarios resembling epidemic settings such as the one that occurred in Chaparral, Colombia in 2004 demonstrates important economic benefits.

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Short communication: The cost‐effectiveness of cutaneous leishmaniasis patient management during an epidemic in Chaparral, Colombia in 2004

Cited by 18 publications

References 10 publications

A Randomized Controlled Trial of Local Heat Therapy Versus Intravenous Sodium Stibogluconate for the Treatment of Cutaneous Leishmania major Infection

A Randomized Controlled Trial of Local Heat Therapy Versus Intravenous Sodium Stibogluconate for the Treatment of Cutaneous Leishmania major Infection

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

The potential economic value of a cutaneous leishmaniasis vaccine in seven endemic countries in the Americas

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