title: 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.
abstract: Convergence of geographic regions endemic for human immunodeficiency virus (HIV) and cutaneous leishmaniasis (CL) raise concerns that HIV co-infection may worsen CL burden, complicating already lengthy and costly CL treatments and highlighting a need for newer therapies. We constructed two Markov decision models to quantify impact of HIV on CL and help establish a target product profile for new CL treatments, accounting for co-infection. 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.
authors.forename: Stephanie D
authors.initials: SD
authors.lastname: Kruchten
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Bacon
authors.forename: Bruce Y
authors.initials: BY
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000981:Antiprotozoal Agents / Q000191:economics / Q000627:therapeutic use*; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D060085:Coinfection; D003198:Computer Simulation; D017281:Cost of Illness; D003661:Decision Support Techniques; D015658:HIV Infections / Q000150:complications / Q000191:economics* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D016773:Leishmaniasis, Cutaneous / Q000150:complications / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D008390:Markov Chains; D008875:Middle Aged; D055815:Young Adult
chemical_list: D000981:Antiprotozoal Agents