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

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.

The direct costs of treating human visceral leishmaniasis in Brazil

Abstract INTRODUCTION: The drugs available for visceral leishmaniasis (VL) treatment in Brazil have specific characteristics in terms of operability, effectiveness, toxicity, and cost. The aim of this study was to estimate the direct costs of therapies recommended by the Ministry of Health (MH) for VL treatment in Brazil. METHODS: The analytical perspective used was that adopted by the Brazilian Public Health System. Three drugs and four regimens were included: 1) N-methyl glucamine antimoniate intramuscularly at 20mg per kg per day for 30 days; 2) N-methyl glucamine antimoniate intravenously at 20mg per kg per day for 30 days; 3) amphotericin B deoxycholate at 1mg per kg per day for 21 days; and 4) liposomal amphotericin B at 3mg per kg per day for a 7 days treatment. RESULTS: The estimated direct costs of treatment for an adult patient using N-methylglucamine antimoniate administered via the intramuscular and intravenous routes were USD 418.52 and USD 669.40, respectively. The estimated cost of treatment with amphotericin B deoxycholate was USD 1,522.70. Finally, the estimated costs of treatment with liposomal amphotericin B were USD 659.79, and USD 11,559.15 using the price adopted by the WHO and the Drug Regulation Board, respectively. CONCLUSIONS: This analysis indicates the economic feasibility of replacing N-methyl glucamine antimoniate with liposomal amphotericin B, which allows a shorter treatment period with less toxicity compared with other treatments, provided that the purchase value used by the WHO and transferred to the MH is maintained.

Tratamiento de infecciones fúngicas sistémicas. III parte: Anfotericina B, aspectos farmacoeconómicos y decisiones terapéuticas / Treatment of systemic fungal infections. III Part: Amphotericin B, pharmacoeconomical aspects and therapeutic decisions

This third part contains a review on amphotericin B, pharmacoeconomical aspects and clinical decision involved during therapy selection of antifungal agents. Amphotericin B, the standard of antifungal therapy is associated with significant infusion adverse events and nephrotoxicity but has the widest spectrum of activity against fungal species involved in human infections. It is a recognized first line-therapy in high-risk patients with criptocococcal meningitis, invasive aspergillosis, mucormicosis, and as an empirical therapy in persistently febrile neutropenic patients without renal failure. Several lipid associated formulations of amphotericin B are available that provide lesser nephrotoxicity but at a considerable higher cost and an adverse cost-effectiveness ratio. Several small-randomized controlled trials of IntralipidO formulations of amphotericin B have been published but controversy remains. Few pharmacoeconomical analysis have been published and mostly refer to lipid associated formulations of amphotericin B versus the conventional form. As stated, potential economical benefits obtained with lipid associated formulations of amphotericin B by avoiding more cases of renal failure are surpassed by their enormous acquisition costs. On the other hand, amphotericin B is a cost-effective alternative compared to a prolonged iv fluconazol therapy but not when switching to oral therapy is scheduled before the first week. Intravenous itraconazole (not available in Chile) is reportedly more cost-effective than conventional amphotericin B for the treatment of persistently febrile neutropenic patients.