115. Cost-effectiveness of meglumine antimoniate and caretaker DOTS miltefosine treatment for cutaneous leishmaniasis for pediatric patients in Colombia
Session: Oral Abstract Session: Global Health
Thursday, October 8, 2015: 11:30 AM
Room: 32--ABC
Background: Oral miltefosine has recently been shown to be non-inferior to first-line, injectible meglumine antimoniate (MA) for the treatment of cutaneous leismaniasis (CL). Miltefosine may be amenable to an in-home caretaker Directly Observed Treatment (DOTS) program, while patients must travel to clinics to receive MA. We examine the cost-effectiveness of pediatric CL treatments with miltefosine by caretaker DOTS versus MA in southwest Colombia. 

Methods: We developed a Monte Carlo model to compare the cost-per-cure of miltefosine by caretaker DOTS compared to MA from the patient, government payer, and societal perspectives. Patient perspective included travel costs,  whereas the government payer perspective included drug costs.  Societal cost equaled patient costs plus government payer costs. Drug effectiveness and adverse events were estimated from three clinical trials. Resource utilization and costs of travel and care were obtained from surveys of medical professionals at four hospitals. National and WHO databases were utilized to establish drug costs and demographic parameters. Trial simulations (n=100,000) were run for each treatment and results were reported in US dollars-per-cure based on a 5-year average exchange rate.

Results: Miltefosine decreased cost-per-cure for society and patients, and slightly increased cost-per-cure to the government payer compared to MA. Mean societal costs were $487 (SD±$198) for MA and $103 (SD±$3) for miltefosine with a per-cure cost ratio (miltefosine/MA) of 0.21. Mean patient costs were $438 (SD ±$187) for MA and $50 (SD±$2) for miltefosine, with a per-cure cost ratio of 0.11.  Mean government payer costs were $49 (SD±$38) for MA and $54 (SD±$3) for miltefosine, with a per-cure cost ratio of 1.09. Results were sensitive to travel costs and drug prices from patient and government payer perspectives, respectively.

Conclusion: Oral miltefosine via caretaker DOTS appears to be cost-effective compared to meglumine antimoniate for the treatment of pediatric cutaneous leishmaniasis due to the obviation of travel in this rural population and minimal increased drug cost. The use of this medication by a caretaker DOTS protocol should be considered in endemic areas.

Brandon Berger, BA1, Alexandra Cossio, RN MSc2, Mai T. Pho, MD MPH3, Maria Del Mar Castro, MD2, Sergio Prada, PhD4, Ramiro Guerrero, MSc4, Allison H. Bartlett, MD, MS5 and Nancy Gore Saravia, PhD2, (1)University of Chicago Pritzker School of Medicine, Chicago, IL, (2)Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM), Cali, Colombia, (3)Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL, (4)PROESA, Universidad Icesi, Cali, Colombia, (5)Department of Pediatrics, Section of Infectious Diseases, University of Chicago Medicine, Chicago, IL

Disclosures:

B. Berger, Infectious Disease Society of America: Member , Research grant
University of Chicago Pritzker School of Medicine: student , Educational grant and Research grant

A. Cossio, None

M. T. Pho, None

M. D. M. Castro, None

S. Prada, None

R. Guerrero, None

A. H. Bartlett, None

N. G. Saravia, None

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