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 3 shows the lifetime costs per co-infection case using the new treatment (across the range of drug cost, treatment seeking likelihood, and cure rate) compared with the NPV of the existing treatment, assuming MCL treatment costs are 1.5 times greater than CL costs, MCL cure rates are 70% that of CL cure rates, and side effect likelihood of 10% (for only new treatment). These results suggest that use of a new treatment could be a cost saving ($1,238–8,464 lifetime costs per co-infection case) at a price point as high as $508 across all drug cure rates evaluated, regardless of the likelihood that treatment was sought. Side effect risk had a maximum impact when the probability of the case-seeking treatment was 90%, where increasing this probability from 1% to 30% increased the NPV per case by ∼2 times. Using the midpoint value assessed for drug cost ($168), side effect risk (10%), and cure rate (70%), the lifetime CL-related cost of an HIV-positive patient was $254, assuming a treatment-seeking probability of 70%. This cost is 30 times lower than the NPV per CL/HIV case ($7,735) using existing treatments and assuming the same treatment seeking likelihood, resulting in a total savings of $7,481 per case.
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.