The impact of human immunodeficiency virus (HIV) co-infection on the economic burden of cutaneous leishmaniasis (CL) in Brazil and potential value of new CL drug treatments.
Bottom Line: The HIV co-infection increased lifetime cost per CL case 11-371 times ($1,349-45,683) that of HIV-negative individuals ($123) and Brazil's CL burden from $1.6-16.0 million to $1.6-65.5 million.A new treatment could be a cost saving at ≤ $254 across several ranges (treatments seeking probabilities, side effect risks, cure rates) and continues to save costs up to $508 across treatment-seeking probabilities with a drug cure rate of ≥ 50%.The HIV co-infection can increase CL burden, suggesting more joint HIV and CL surveillance and control efforts are needed.
Affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.Show MeSH
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Mentions: Figure 2 shows the impact of CL/HIV co-infection prevalence and total CL case estimates on the economic burden of CL in Brazil over the lifetime of current cases, assuming MCL treatment costs are 1.5 times greater than CL costs, MCL cure rates are 70% of CL cure rates, and a treatment-seeking probability of 70%. Even if current estimates of CL cases in Brazil were cut by half to 13,004 and co-infection prevalence by 90–0.01%, the NPV of total CL treatment costs would still be over $1.6 million. Using current case CL and co-infection prevalence estimates yield an NPV of place this burden around $3.4 million, and underreporting rates suggested by some (2.8–4.6 times case reports) could increase the NPV to $15.6 million. Failing to consider these added costs associated with HIV co-infection when estimating the economic burden of CL in Brazil would yield an NPV of $1.6–16.0 million (assuming an NPV of $123 per case), which accounts for 99–24% of our nationwide estimates ($1.6–65.5 million) when considering HIV co-infection prevalence of 0.01–5% and a prevalence of 0.5–5 times the current reports.
Affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.