Cost-effectiveness projections of single and combination therapies for visceral leishmaniasis in Bihar, India.
OBJECTIVE
To assess the cost-effectiveness of current monotherapies and prospective combinations for treating visceral leishmaniasis (VL) in Bihar, India in terms of years of life lost (YLL) averted as well as deaths averted.


METHODS
We employed two methods to estimate the number of avertable deaths in our analysis: one using estimated mortality, the other using direct incidence estimates for VL. Costs of care are based on an average private hospital in Bihar, and data on drug costs were obtained both locally and from the World Health Organization.


RESULTS
The cost of monotherapies per averted YLL ranged from US$2 for paromomycin in an outpatient setting to US$20-22 for AmBisome at 20 mg/kg. The corresponding costs per death averted ranged from US$53-54 to US$523-527. Combinations ranged US$5-8 per YLL averted and US$124-213 per death averted.


CONCLUSIONS
The available treatments for VL are cost-effective, and our mortality and incidence-based methods produce consistent estimates. The combinations considered here were more cost-effective than most monotherapies. Having multiple treatment options and combining drugs are also likely to reduce drug pressure and prolong the drugs' life-span of effective use.
Olliaro
Piero
P
UNICEF/UNDP/WB/WHO Special Programme for Research and Training in Tropical Diseases, Geneva, Switzerland. olliarop@who.int
Darley
Sarah
S
Laxminarayan
Ramanan
R
Sundar
Shyam
S
D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage* / Q000191:economics; D000981:Antiprotozoal Agents / Q000008:administration & dosage* / Q000191:economics; D002648:Child; D003362:Cost-Benefit Analysis; D004180:Direct Service Costs; D004334:Drug Administration Schedule; D016527:Drug Costs; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007194:India; D007898:Leishmaniasis, Visceral / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D008297:Male; D010303:Paromomycin / Q000008:administration & dosage* / Q000191:economics; D010767:Phosphorylcholine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D017410:Practice Guidelines as Topic; D055815:Young Adult
D000981:Antiprotozoal Agents; C068538:liposomal amphotericin B; D010767:Phosphorylcholine; C039128:miltefosine; D010303:Paromomycin; D000666:Amphotericin B