Estimating direct costs of the treatment for mucosal leishmaniasis in Brazil

Abstract

INTRODUCTION: The objective of this study was to estimate the direct medical costs of the treatment for mucosal leishmaniasis (ML) using three therapeutic approaches in the Brazilian context. METHODS: We performed this economic assessment from the perspective of the Brazilian public healthcare system. The following therapeutic approaches were evaluated: meglumine antimoniate, liposomal amphotericin B, and miltefosine. Direct medical costs were estimated considering four treatment components: a) drug, b) combined medical products, c) procedures, and d) complementary tests. RESULTS: Treatment with meglumine antimoniate had the lowest average cost per patient (US$ 167.66), followed by miltefosine (US$ 259.92) in the outpatient treatment regimen. The average cost of treatment with liposomal amphotericin B was US$ 715.35 both in inpatient regimen. In all estimates, the drugs accounted for more than 60% of the total cost for each treatment approach. CONCLUSIONS: These results demonstrate the marked differences in costs between the therapeutic alternatives for ML. In addition to efficacy rates and costs related to adverse events, our data have the potential to support a complete cost-effectiveness study in the future. Complete analyses comparing costs and benefits for interventions will assist health managers in choosing drugs for ML treatment in Brazil as well as in establishing effective public health policies.

A Pilot Randomized Clinical Trial: Oral Miltefosine and Pentavalent Antimonials Associated With Pentoxifylline for the Treatment of American Tegumentary Leishmaniasis

“…Injectable PAs have been used since the 1940s to treat ATL and are currently the recommended first-line treatments in Brazil ( Ministério da Saúde, 2017 ). Treatment with PAs requires daily intravenous or intramuscular injections for 20 to 30 days in areas with a high risk of ML, which means that patients have to go every day during the treatment period to a healthcare facility to receive the medication, which can impose additional burdens on the healthcare system and the patient ( Burza et al., 2018 ; Chakravarty and Sundar, 2019 ; Carvalho et al., 2021 ).…”

“…In 2021, the estimated cost of treating patients with ML in Brazil with PAs and pentoxifylline for 30 days was US$167.66, while the cost of treatment with 150 mg/day miltefosine for 28 days was US$259.92 ( Carvalho et al., 2021 ). However, in that cost evaluation, the eventual expenses arising from the occurrence of AEs, treatment interruptions and treatment failure with the subsequent need for other treatments were not considered, and these expenses can be relatively higher with PAs.…”

“…The idea of combining treatments to reduce AEs, increase cure rates, and reduce drug resistance is promising ( Santarem et al., 2014 ). The possibility of using only oral drugs has the benefit of facilitating drug administration and increasing treatment adherence ( Carvalho et al., 2021 ). As the real effect of combined treatment with miltefosine and pentoxifylline is unknown and no data have been published, we relied on a post hoc analysis, effect sizes and confidence intervals to assess the feasibility of future trials.…”

Economic evaluations addressing diagnosis and treatment strategies for neglected tropical diseases: an overview

“…Carvalho et al 19 estimated the direct medical costs of the treatment for mucosal leishmaniasis using three therapeutic approaches in the Brazilian context: meglumine antimoniate, liposomal amphotericin B, and miltefosine. Treatment with meglumine antimoniate had the lowest average cost per patient (US$ 167.66), followed by miltefosine (US$ 259.92) in the outpatient treatment regimen.…”

Mebendazole Inhibits Histoplasma capsulatum In Vitro Growth and Decreases Mitochondrion and Cytoskeleton Protein Levels

“…In Europe, a 15-day intravenous treatment with liposomal amphotericin B is estimated to cost from €10,000 to €20,000 [ 8 ]. In Brazil, the daily average cost of treatment with liposomal amphotericin B was US$ 715.35 in an inpatient regimen [ 9 ]. The drug–drug interactions and the side effects are major issues associated with itraconazole therapy.…”