Cost-effectiveness of diagnostic-therapeutic strategies for paediatric visceral leishmaniasis in Morocco

• Published in: BMJ global health Vol. 2; no. 3; p. e000315
• Main Authors: Alonso, Sergi, Tachfouti, Nabil, Najdi, Adil, Sicuri, Elisa, Picado, Albert
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.08.2017; BMJ; BMJ Global Health
• Subjects: Algorithms; Antifungal agents; Bone marrow; Children & youth; Cost analysis; Decision trees; Diagnostic tests; Drug dosages; Economia de la salut; Global health; Leishmaniasis; Leishmaniosi; Marroc; Medical diagnosis; Medical economics; Morocco; Parasites; Parasitic diseases; Patients; Pediatria; Pediatrics; Rural areas; Serology; Vector-borne diseases; Greece; Italy; Morocco; United States > US; Spain; Mediterranean Area; treatment; visceral leishmaniasis; diagnostics and tools; health economics
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2017-000315

IntroductionVisceral leishmaniasis (VL) is a neglected parasitic disease with a high fatality rate if left untreated. Endemic in Morocco, as well as in other countries in the Mediterranean basin, VL mainly affects children living in rural areas. In Morocco, the direct observation of Leishmania parasites in bone marrow (BM) aspirates is used to diagnose VL and meglumine antimoniate (SB) is the first line of treatment. Less invasive, more efficacious and safer alternatives exist. In this study we estimate the cost-effectiveness of alternative diagnostic-therapeutic algorithms for paediatric VL in Morocco.MethodsA decision tree was used to estimate the cost-effectiveness of using BM or rapid diagnostic tests (RDTs) as diagnostic tools and/or SB or two liposomal amphotericin B (L-AmB) regimens: 6-day and 2-day courses to treat VL. Incremental cost-effectiveness ratios, expressed as cost per death averted, were estimated by comparing costs and effectiveness of the alternative algorithms. A threshold analysis evaluated at which price L-AmB became cost-effective compared with current practices.ResultsImplementing RDT and/or L-AmB treatments would be cost-effective in Morocco according to the WHO thresholds. Introducing the 6-day course L-AmB, current second-line treatment, would be highly cost-effective if L-AmB price was below US$100/phial. The 2-day L-AmB treatment, current standard treatment of paediatric VL in France, is highly cost-effective, with L-AmB at its market price (US$165/phial).ConclusionsThe results of this study should encourage the implementation of RDT and/or short-course L-AmB treatments for paediatric VL management in Morocco and other North African countries.