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.
Infectious Disease Society of America:
University of Chicago Pritzker School of Medicine: student , Educational grant and Research grant
M. T. Pho, None
M. D. M. Castro, None
S. Prada, None
R. Guerrero, None
A. H. Bartlett, None
N. G. Saravia, None