Abstract:
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INTRODUCTION: Visceral leishmaniasis (VL) is a neglected
parasitic disease with a high fatality rate if left untreated.
Endemic in Morocco, as well as in other countries in the
Mediterranean basin, VL mainly affects children living in rural
areas. In Morocco, the direct observation of Leishmania
parasites in bone marrow (BM) aspirates is used to diagnose VL
and meglumine antimoniate (SB) is the first line of treatment.
Less invasive, more efficacious and safer alternatives exist. In
this study we estimate the cost-effectiveness of alternative
diagnostic-therapeutic algorithms for paediatric VL in Morocco.
METHODS: A decision tree was used to estimate the
cost-effectiveness of using BM or rapid diagnostic tests (RDTs)
as diagnostic tools and/or SB or two liposomal amphotericin B
(L-AmB) regimens: 6-day and 2-day courses to treat VL.
Incremental cost-effectiveness ratios, expressed as cost per
death averted, were estimated by comparing costs and
effectiveness of the alternative algorithms. A threshold
analysis evaluated at which price L-AmB became cost-effective
compared with current practices. RESULTS: Implementing RDT
and/or L-AmB treatments would be cost-effective in Morocco
according to the WHO thresholds. Introducing the 6-day course
L-AmB, current second-line treatment, would be highly
cost-effective if L-AmB price was below US$100/phial. The 2-day
L-AmB treatment, current standard treatment of paediatric VL in
France, is highly cost-effective, with L-AmB at its market price
(US$165/phial). CONCLUSIONS: The results of this study should
encourage the implementation of RDT and/or short-course L-AmB
treatments for paediatric VL management in Morocco and other
North African countries. |