Cost-effectiveness analysis of combination therapies for visceral leishmaniasis in the Indian subcontinent.
Visceral leishmaniasis is a systemic parasitic disease that is fatal unless treated. We assessed the cost and cost-effectiveness of alternative strategies for the treatment of visceral leishmaniasis in the Indian subcontinent. In particular we examined whether combination therapies are a cost-effect...
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ftdoajarticles:oai:doaj.org/article:1b94192520814d009486334c90a4d33e 2023-05-15T15:16:50+02:00 Cost-effectiveness analysis of combination therapies for visceral leishmaniasis in the Indian subcontinent. Filip Meheus Manica Balasegaram Piero Olliaro Shyam Sundar Suman Rijal Md Abul Faiz Marleen Boelaert 2010-09-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0000818 https://doaj.org/article/1b94192520814d009486334c90a4d33e EN eng Public Library of Science (PLoS) http://europepmc.org/articles/PMC2935395?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0000818 https://doaj.org/article/1b94192520814d009486334c90a4d33e PLoS Neglected Tropical Diseases, Vol 4, Iss 9 (2010) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2010 ftdoajarticles https://doi.org/10.1371/journal.pntd.0000818 2022-12-31T10:36:11Z Visceral leishmaniasis is a systemic parasitic disease that is fatal unless treated. We assessed the cost and cost-effectiveness of alternative strategies for the treatment of visceral leishmaniasis in the Indian subcontinent. In particular we examined whether combination therapies are a cost-effective alternative compared to monotherapies.We assessed the cost-effectiveness of all possible mono- and combination therapies for the treatment of visceral leishmaniasis in the Indian subcontinent (India, Nepal and Bangladesh) from a societal perspective using a decision analytical model based on a decision tree. Primary data collected in each country was combined with data from the literature and an expert poll (Delphi method). The cost per patient treated and average and incremental cost-effectiveness ratios expressed as cost per death averted were calculated. Extensive sensitivity analysis was done to evaluate the robustness of our estimations and conclusions. With a cost of US$92 per death averted, the combination miltefosine-paromomycin was the most cost-effective treatment strategy. The next best alternative was a combination of liposomal amphotericin B with paromomycin with an incremental cost-effectiveness of $652 per death averted. All other strategies were dominated with the exception of a single dose of 10mg per kg of liposomal amphotericin B. While strategies based on liposomal amphotericin B (AmBisome) were found to be the most effective, its current drug cost of US$20 per vial resulted in a higher average cost-effectiveness. Sensitivity analysis showed the conclusion to be robust to variations in the input parameters over their plausible range.Combination treatments are a cost-effective alternative to current monotherapy for VL. Given their expected impact on the emergence of drug resistance, a switch to combination therapy should be considered once final results from clinical trials are available. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Indian PLoS Neglected Tropical Diseases 4 9 e818 |
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Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Filip Meheus Manica Balasegaram Piero Olliaro Shyam Sundar Suman Rijal Md Abul Faiz Marleen Boelaert Cost-effectiveness analysis of combination therapies for visceral leishmaniasis in the Indian subcontinent. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Visceral leishmaniasis is a systemic parasitic disease that is fatal unless treated. We assessed the cost and cost-effectiveness of alternative strategies for the treatment of visceral leishmaniasis in the Indian subcontinent. In particular we examined whether combination therapies are a cost-effective alternative compared to monotherapies.We assessed the cost-effectiveness of all possible mono- and combination therapies for the treatment of visceral leishmaniasis in the Indian subcontinent (India, Nepal and Bangladesh) from a societal perspective using a decision analytical model based on a decision tree. Primary data collected in each country was combined with data from the literature and an expert poll (Delphi method). The cost per patient treated and average and incremental cost-effectiveness ratios expressed as cost per death averted were calculated. Extensive sensitivity analysis was done to evaluate the robustness of our estimations and conclusions. With a cost of US$92 per death averted, the combination miltefosine-paromomycin was the most cost-effective treatment strategy. The next best alternative was a combination of liposomal amphotericin B with paromomycin with an incremental cost-effectiveness of $652 per death averted. All other strategies were dominated with the exception of a single dose of 10mg per kg of liposomal amphotericin B. While strategies based on liposomal amphotericin B (AmBisome) were found to be the most effective, its current drug cost of US$20 per vial resulted in a higher average cost-effectiveness. Sensitivity analysis showed the conclusion to be robust to variations in the input parameters over their plausible range.Combination treatments are a cost-effective alternative to current monotherapy for VL. Given their expected impact on the emergence of drug resistance, a switch to combination therapy should be considered once final results from clinical trials are available. |
format |
Article in Journal/Newspaper |
author |
Filip Meheus Manica Balasegaram Piero Olliaro Shyam Sundar Suman Rijal Md Abul Faiz Marleen Boelaert |
author_facet |
Filip Meheus Manica Balasegaram Piero Olliaro Shyam Sundar Suman Rijal Md Abul Faiz Marleen Boelaert |
author_sort |
Filip Meheus |
title |
Cost-effectiveness analysis of combination therapies for visceral leishmaniasis in the Indian subcontinent. |
title_short |
Cost-effectiveness analysis of combination therapies for visceral leishmaniasis in the Indian subcontinent. |
title_full |
Cost-effectiveness analysis of combination therapies for visceral leishmaniasis in the Indian subcontinent. |
title_fullStr |
Cost-effectiveness analysis of combination therapies for visceral leishmaniasis in the Indian subcontinent. |
title_full_unstemmed |
Cost-effectiveness analysis of combination therapies for visceral leishmaniasis in the Indian subcontinent. |
title_sort |
cost-effectiveness analysis of combination therapies for visceral leishmaniasis in the indian subcontinent. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2010 |
url |
https://doi.org/10.1371/journal.pntd.0000818 https://doaj.org/article/1b94192520814d009486334c90a4d33e |
geographic |
Arctic Indian |
geographic_facet |
Arctic Indian |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 4, Iss 9 (2010) |
op_relation |
http://europepmc.org/articles/PMC2935395?pdf=render https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0000818 https://doaj.org/article/1b94192520814d009486334c90a4d33e |
op_doi |
https://doi.org/10.1371/journal.pntd.0000818 |
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PLoS Neglected Tropical Diseases |
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9 |
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e818 |
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