title: Cost of Pediatric Visceral Leishmaniasis Care in Morocco.
abstract: BACKGROUND
  Visceral leishmaniasis (VL) is a neglected parasitic disease that is fatal if left untreated. VL is endemic in Morocco and other countries in North Africa were it mainly affects children from rural areas. In Morocco, the direct observation of Leishmania parasites in bone marrow aspirates and serological tests are used to diagnose VL. Glucantime is the first line of treatment. The objective of this study was to report the costs associated to standard clinical management of pediatric VL from the provider perspective in Morocco. As a secondary objective we described the current clinical practices and the epidemiological characteristics of pediatric VL patients.
  
  
  METHODS
  From March to June 2014 we conducted a survey in eight hospitals treating pediatric VL patients in Morocco. A pro-forma was used to collect demographic, clinical and management data from medical records. We specifically collected data on VL diagnosis and treatment. We also estimated the days of hospitalization and the time to start VL treatment. Costs were estimated by multiplying the use of resources in terms of number of days in hospital, tests performed and drugs provided by the official prices. For patients receiving part of their treatment at Primary Health Centers (PHC) we estimated the cost of administering the Glucantime as outpatient. We calculated the median cost per VL patient. We also estimated the cost of managing a VL case when different treatment strategies were applied: inpatient and outpatient.
  
  
  RESULTS
  We obtained data from 127 VL patients. The median total cost per pediatric VL case in Morocco is 520 US$. The cost in hospitals applying an outpatient strategy is significantly lower (307 US$) than hospitals keeping the patients for the whole treatment (636 US$). However the outpatient strategy is not yet recommended as VL treatment for children in the Moroccan guidelines. VL diagnosis and treatment regimens should be standardized following the current guidelines in Morocco.
authors.affiliation: Laboratory of Epidemiology, clinical Research and Community Health, Faculty of Medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco.
authors.forename: Nabil
authors.initials: N
authors.lastname: Tachfouti
authors.affiliation: Laboratory of Epidemiology, clinical Research and Community Health, Faculty of Medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco.
authors.forename: Adil
authors.initials: A
authors.lastname: Najdi
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Sergi
authors.initials: S
authors.lastname: Alonso
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Elisa
authors.initials: E
authors.lastname: Sicuri
authors.affiliation: Center of Epidemiology and disease Control, Ministry of Health, Rabat, Morocco.
authors.forename: Abderahmane
authors.initials: A
authors.lastname: Laamrani El Idrissi
authors.affiliation: Laboratory of Epidemiology, clinical Research and Community Health, Faculty of Medicine and pharmacy of Fez, Sidi Mohamed Ben Abdellah University, Fez, Morocco.|Ecole Nationale de Santé Publique (ENSP), Ministry of Health, Rabat, Morocco.
authors.forename: Chakib
authors.initials: C
authors.lastname: Nejjari
authors.affiliation: ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Picado
mesh_terms: D000981:Antiprotozoal Agents / Q000191:economics* / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D007898:Leishmaniasis, Visceral / Q000188:drug therapy / Q000191:economics*; D008297:Male; D008536:Meglumine / Q000191:economics* / Q000627:therapeutic use; D000077485:Meglumine Antimoniate; D009018:Morocco; D058069:Neglected Diseases / Q000188:drug therapy / Q000191:economics*; D009942:Organometallic Compounds / Q000191:economics* / Q000627:therapeutic use
chemical_list: D000981:Antiprotozoal Agents; D009942:Organometallic Compounds; D008536:Meglumine; D000077485:Meglumine Antimoniate