title: The cost-effectiveness of ivermectin vs. albendazole in the presumptive treatment of strongyloidiasis in immigrants to the United States.
abstract: The presumptive treatment of parasitosis among immigrants with albendazole has been shown to save both money and lives, primarily via a reduction in the burden of Strongyloides stercoralis. Ivermectin is more effective than albendazole, but is also more expensive. This coupled with confusion surrounding the cost-effectiveness of guiding therapy based on eosinophil counts has led to disparate practices. We used the newly arrived year 2000 immigrant population as a hypothetical cohort in a decision analysis model to examine the cost-effectiveness of various interventions to reduce parasitosis among immigrants. When the prevalence of S. stercoralis is greater than 2%, the incremental cost-effectiveness ratios of all presumptive treatment strategies were similar. Ivermectin is associated with an incremental cost-effectiveness ratio of 1700 dollars per QALY gained for treatment with 12 mg ivermectin relative to 5 days of albendazole when the prevalence is 10%. Any presumptive treatment strategy is cost-effective when compared with most common medical interventions.
authors.affiliation: Department of Health Policy and Management, Mailman School of Public Health, Columbia University, NY 10032, USA. pm124@columbia.edu
authors.forename: P
authors.initials: P
authors.lastname: Muennig
authors.forename: D
authors.initials: D
authors.lastname: Pallin
authors.forename: C
authors.initials: C
authors.lastname: Challah
authors.forename: K
authors.initials: K
authors.lastname: Khan
mesh_terms: D015766:Albendazole / Q000191:economics* / Q000627:therapeutic use*; D000818:Animals; D000871:Anthelmintics / Q000191:economics* / Q000627:therapeutic use*; D000969:Antinematodal Agents / Q000191:economics* / Q000627:therapeutic use*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003657:Decision Making; D004641:Emigration and Immigration; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007559:Ivermectin / Q000191:economics* / Q000627:therapeutic use*; D015995:Prevalence; D017171:Strongyloides stercoralis / Q000472:pathogenicity; D013322:Strongyloidiasis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D014481:United States
chemical_list: D000871:Anthelmintics; D000969:Antinematodal Agents; D007559:Ivermectin; D015766:Albendazole