Cost-effectiveness analysis of diagnostic-therapeutic strategies for visceral leishmaniasis in Brazil

Assis, Tália Santana Machado de; Rabello, Ana; Cota, Gláucia; Werneck, Guilherme Loureiro; Azeredo-da-Silva, André Luís Ferreira de

doi:10.1590/0037-8682-0272-2018

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Short Communication • Rev. Soc. Bras. Med. Trop. 52 • 2019 • https://doi.org/10.1590/0037-8682-0272-2018 copy

Cost-effectiveness analysis of diagnostic-therapeutic strategies for visceral leishmaniasis in Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

INTRODUCTION:

Visceral leishmaniasis (VL) is fatal if not diagnosed and treated. This study aimed to estimate the cost-effectiveness of diagnostic-therapeutic alternatives for VL in Brazil.

METHODS:

A decision model estimated the life expectancy and costs of six diagnostic-therapeutic strategies.

RESULTS:

IT LEISH + liposomal amphotericin B emerged the best option, presenting lower costs and higher effectiveness. DAT-LPC + liposomal amphotericin B showed an incremental cost-effectiveness ratio of US$ 326.31 per life year.

CONCLUSIONS:

These findings indicate the feasibility of incorporating DAT and designating liposomal amphotericin B as the first-line drug for VL in Brazil.

Keywords:
Visceral leishmaniasis; Cost-effectiveness; Diagnosis; Therapy

Details	Probability	Diagnostic tests			Therapeutics strategies		Reference
		IT LEISH	IFAT^a	DAT-LPC^b	N-methylglucamine antimoniate	Liposomal amphotericin B
Prior probability of visceral leishmaniasis %	0.67	-	-	-	-	-	Machado de Assis et al.¹⁰10. Machado de Assis TS, Azeredo da Silva ALF, Werneck G, Rabello A. Cost-effectiveness analysis of diagnostic tests for human visceral leishmaniasis in Brazil. Trans R Soc Trop Med Hyg . 2016;110(8):464-71.
Sensitivity %	-	94.0	88.3	99.0	-	-	Machado de Assis et al.¹⁰10. Machado de Assis TS, Azeredo da Silva ALF, Werneck G, Rabello A. Cost-effectiveness analysis of diagnostic tests for human visceral leishmaniasis in Brazil. Trans R Soc Trop Med Hyg . 2016;110(8):464-71.
Confidence interval 95%		90.1-96.3	84.0-92.0	94.0-100
Specificity %	-	100	83.0	98.0	-	-	Machado de Assis et al.¹⁰10. Machado de Assis TS, Azeredo da Silva ALF, Werneck G, Rabello A. Cost-effectiveness analysis of diagnostic tests for human visceral leishmaniasis in Brazil. Trans R Soc Trop Med Hyg . 2016;110(8):464-71.
Confidence interval 95%		97-100	75.0-88.2	93.0-100
Cure rate %	-	-	-	-	77.5	87.2	Romero et al.¹³13. Romero GAS, Costa DL, Costa CHN, de Almeida RP, de Melo EV, de Carvalho SFG, et al. Efficacy and safety of available treatments for visceral leishmaniasis in Brazil: A multicenter, randomized, open label trial. PLoS Negl Trop Dis. 2017;11(6):e0005706.
Confidence interval 95%					68.6-84.9	79.4-92.8
Adverse events %	-	-	-	-	75.0	65.0	Romero et al.¹³13. Romero GAS, Costa DL, Costa CHN, de Almeida RP, de Melo EV, de Carvalho SFG, et al. Efficacy and safety of available treatments for visceral leishmaniasis in Brazil: A multicenter, randomized, open label trial. PLoS Negl Trop Dis. 2017;11(6):e0005706.
Confidence interval 95%					65.6-82.5	55.4-74.0
Direct cost US$	-	6.57	11.39	4.92	669.40	659.79	Machado de Assis et al.¹⁰10. Machado de Assis TS, Azeredo da Silva ALF, Werneck G, Rabello A. Cost-effectiveness analysis of diagnostic tests for human visceral leishmaniasis in Brazil. Trans R Soc Trop Med Hyg . 2016;110(8):464-71.,¹⁵15. Machado de Assis TS, Rosa DCP, Teixeira EM, Cota G, Azeredo-da-Silva ALF, Werneck G, et al. The direct costs of treating human visceral leishmaniasis in Brazil. Rev Soc Bras Med Trop. 2017;50(4):478-82.
Range ± 25%		4.92-8.21	8.54-14.23	3.69-6.15	502.05-836.74	494.85-824.73

Diagnostic-therapeutic strategies	Cost	Effectiveness with a	Effectiveness without a	ICER^a with a discount of	ICER^a without a discount of 5%
	(US$)	discount of 5% year	discount of 5% year	5% year (US$)	year (US$)
			Analysis 1
IT LEISH + liposomal amphotericin B	440.25	2.40	62.95	-	-
IT LEISH ⁺ N-methylglucamine antimoniate	449.09	2.22	58.43	Dominated	Dominated
IFAT^b + liposomal amphotericin B	456.02	2.30	60.44	Dominated	Dominated
IFAT^{b +} N-methylglucamine antimoniate	465.08	2.14	56.21	Dominated	Dominated
			Analysis 2
IT LEISH + liposomal amphotericin B	440.25	2.40	62.95	-	-
IT LEISH ⁺ N-methylglucamine antimoniate	449.09	2.22	58.43	Dominated	Dominated
IFAT^b + liposomal amphotericin B	456.02	2.30	60.44	Dominated	Dominated
IFAT^{b +} N-methylglucamine antimoniate	465.08	2.14	56.21	Dominated	Dominated
DAT-LPC^c + liposomal amphotericin B	466.21	2.48	65.04	326.31	12.42
DAT-LPC^c + N-methylglucamine antimoniate	472.55	2.30	60.28	Dominated	Dominated

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[1] Corresponding Author: Tália Santana Machado de Assis. e-mail:talia@cpqrr.fiocruz.br / talia@cefetmg.br