Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis.
India has the highest burden of leprosy in the world. Following a recent WHO guideline, the Indian National Leprosy Programme is introducing post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) in all high-endemic districts of the country. The aim of this study is to estimate the long-ter...
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ftdoajarticles:oai:doaj.org/article:5cb5728296ea42b8afac69b126d7a3fb 2023-05-15T15:16:01+02:00 Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis. Anuj Tiwari David J Blok Mohammad Arif Jan Hendrik Richardus 2020-08-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0008521 https://doaj.org/article/5cb5728296ea42b8afac69b126d7a3fb EN eng Public Library of Science (PLoS) https://doi.org/10.1371/journal.pntd.0008521 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0008521 https://doaj.org/article/5cb5728296ea42b8afac69b126d7a3fb PLoS Neglected Tropical Diseases, Vol 14, Iss 8, p e0008521 (2020) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2020 ftdoajarticles https://doi.org/10.1371/journal.pntd.0008521 2022-12-31T09:15:21Z India has the highest burden of leprosy in the world. Following a recent WHO guideline, the Indian National Leprosy Programme is introducing post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) in all high-endemic districts of the country. The aim of this study is to estimate the long-term cost-effectiveness of SDR-PEP in different leprosy disability burden situations. We used a stochastic individual-based model (SIMCOLEP) to simulate the leprosy new case detection rate trend and the impact of implementing contact screening and SDR-PEP from 2016 to 2040 (25 years) in the Union Territory of Dadra Nagar Haveli (DNH) in India. Effects of the intervention were expressed as disability adjusted life years (DALY) averted under three assumption of disability prevention: 1) all grade 1 disability (G1D) cases prevented; 2) G1D cases prevented in PB cases only; 3) no disability prevented. Costs were US$ 2.9 per contact. Costs and effects were discounted at 3%. The incremental cost per DALY averted by SDR-PEP was US$ 210, US$ 447, and US$ 5,673 in the 25th year under assumption 1, 2, and 3, respectively. If prevention of G1D was assumed, the probability of cost-effectiveness was 1.0 at the threshold of US$ 2,000, which is equivalent to the GDP per capita of India. The probability of cost-effectiveness was 0.6, if no disability prevention was assumed. The cost per new leprosy case averted was US$ 2,873. Contact listing, screening and the provision of SDR-PEP is a cost-effective strategy in leprosy control in both the short (5 years) and long term (25 years). The cost-effectiveness depends on the extent to which disability can be prevented. As the intervention becomes increasingly cost-effective in the long term, we recommend a long-term commitment for its implementation. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Daly ENVELOPE(63.761,63.761,-67.513,-67.513) Indian PLOS Neglected Tropical Diseases 14 8 e0008521 |
institution |
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 Anuj Tiwari David J Blok Mohammad Arif Jan Hendrik Richardus Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
India has the highest burden of leprosy in the world. Following a recent WHO guideline, the Indian National Leprosy Programme is introducing post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) in all high-endemic districts of the country. The aim of this study is to estimate the long-term cost-effectiveness of SDR-PEP in different leprosy disability burden situations. We used a stochastic individual-based model (SIMCOLEP) to simulate the leprosy new case detection rate trend and the impact of implementing contact screening and SDR-PEP from 2016 to 2040 (25 years) in the Union Territory of Dadra Nagar Haveli (DNH) in India. Effects of the intervention were expressed as disability adjusted life years (DALY) averted under three assumption of disability prevention: 1) all grade 1 disability (G1D) cases prevented; 2) G1D cases prevented in PB cases only; 3) no disability prevented. Costs were US$ 2.9 per contact. Costs and effects were discounted at 3%. The incremental cost per DALY averted by SDR-PEP was US$ 210, US$ 447, and US$ 5,673 in the 25th year under assumption 1, 2, and 3, respectively. If prevention of G1D was assumed, the probability of cost-effectiveness was 1.0 at the threshold of US$ 2,000, which is equivalent to the GDP per capita of India. The probability of cost-effectiveness was 0.6, if no disability prevention was assumed. The cost per new leprosy case averted was US$ 2,873. Contact listing, screening and the provision of SDR-PEP is a cost-effective strategy in leprosy control in both the short (5 years) and long term (25 years). The cost-effectiveness depends on the extent to which disability can be prevented. As the intervention becomes increasingly cost-effective in the long term, we recommend a long-term commitment for its implementation. |
format |
Article in Journal/Newspaper |
author |
Anuj Tiwari David J Blok Mohammad Arif Jan Hendrik Richardus |
author_facet |
Anuj Tiwari David J Blok Mohammad Arif Jan Hendrik Richardus |
author_sort |
Anuj Tiwari |
title |
Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis. |
title_short |
Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis. |
title_full |
Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis. |
title_fullStr |
Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis. |
title_full_unstemmed |
Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis. |
title_sort |
leprosy post-exposure prophylaxis in the indian health system: a cost-effectiveness analysis. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2020 |
url |
https://doi.org/10.1371/journal.pntd.0008521 https://doaj.org/article/5cb5728296ea42b8afac69b126d7a3fb |
long_lat |
ENVELOPE(63.761,63.761,-67.513,-67.513) |
geographic |
Arctic Daly Indian |
geographic_facet |
Arctic Daly Indian |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 14, Iss 8, p e0008521 (2020) |
op_relation |
https://doi.org/10.1371/journal.pntd.0008521 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0008521 https://doaj.org/article/5cb5728296ea42b8afac69b126d7a3fb |
op_doi |
https://doi.org/10.1371/journal.pntd.0008521 |
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PLOS Neglected Tropical Diseases |
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14 |
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e0008521 |
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