Cost-effectiveness analysis of diagnostic tests for human visceral leishmaniasis in Brazil.
The objective of study was to estimate the incremental cost-effectiveness ratio (ICER) of diagnostic options for visceral leishmaniasis (VL) in Brazil.



Six diagnostic tests were considered: IT LEISH, Kalazar Detect, DAT-LPC (DAT made in the Laboratório de Pesquisas Clínicas), IFAT, PCR and direct examination of bone marrow aspirate performed in either an ambulatory or a hospital setting. A database was built using the cost and effectiveness. The perspective of this study was the Brazilian public healthcare system and the results were expressed in costs per correctly diagnosed cases.



In a favorable hypothetical scenario, DAT-LPC presented the lowest cost (US$4.92) and highest effectiveness (99%). Paired analyses showed that IT LEISH was dominant compared to IFAT, microscopy and Kalazar Detect and that Kalazar Detect was dominant over IFAT and microscopy. PCR was dominant over the bone marrow aspirate in the hospital and showed an ICER of 57.76 compared with aspirate in an ambulatory setting.



These results highlight the need for the revision of algorithm for VL diagnostic in Brazil. Replacements of IFAT with DAT-LPC, Kalazar Detect with IT LEISH and bone marrow aspirate performed in a hospital setting with PCR are cost-effective public health measures.
Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou/Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil Centro Federal de Educação Tecnológica de Minas Gerais, Contagem, Minas Gerais, Brazil taliamachado@contagem.cefetmg.br.
Tália S
TS
Machado de Assis
Instituto para Avaliação de Tecnologias em Saúde, Porto Alegre, Rio Grande do Sul, Brazil Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
André Luis Ferreira
AL
Azeredo-da-Silva
Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
Guilherme Loureiro
GL
Werneck
Laboratório de Pesquisas Clínicas, Centro de Pesquisas René Rachou/Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil.
Ana
A
Rabello
D000465:Algorithms; D001707:Biopsy, Needle; D001938:Brazil; D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000592:standards; D019084:Fluorescent Antibody Technique, Indirect; D017048:Health Care Costs; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000191:economics; D011634:Public Health; D011933:Reagent Kits, Diagnostic; D012680:Sensitivity and Specificity
D011933:Reagent Kits, Diagnostic
Brazil; Cost-effectiveness; Diagnostic tests; Visceral leishmaniasis