Cost-effectiveness of a canine visceral leishmaniasis control program in Brazil based on insecticide-impregnated collars

Abstract

INTRODUCTION: The use of insecticide-impregnated dog collars is a potentially useful tool for the control of visceral leishmaniasis. The objective of the present study was to perform a cost-effectiveness analysis of a program based on insecticide-impregnated collars compared to traditional visceral leishmaniasis control strategies used in Brazil. METHODS: A cost-effectiveness analysis was performed from the perspective of the Unified Health System, using data from the Visceral Leishmaniasis Control Program implemented in the municipality of Montes Claros, Minas Gerais. The direct costs of the three control strategies, which were 1) canine infection screening + sacrifice, 2) residual chemical control of the vector, and 3) insecticide-impregnated dog collars (Scalibor ® ), were evaluated over the two-year study period. RESULTS: The total cost of the program in the area subjected to the traditional control strategies (strategies 1 and 2; control area) was R$ 1,551,699.80, and in the area subjected to all three control strategies (intervention area), it was R$ 1,898,190.16. The collar program was considered highly cost-effective at preventing canine visceral leishmaniasis (incremental cost-effectiveness ratio of approximately R$ 578 per avoided dog sacrifice). CONCLUSIONS: These results provide support for the decision by the Brazilian Ministry of Health in 2019 to provide insecticide-impregnated collars for the control of canine visceral leishmaniasis in a pilot project.

Real-life quantitative G6PD screening in Plasmodium vivax patients in the Brazilian Amazon: A cost-effectiveness analysis

“…The ICER of US$495.32 per additional PQ-associated hospitalization avoided is less than 8% of one Brazilian GDP per capita (US$6,822). Although there is no explicit value to the cost-effectiveness threshold for a very efficient intervention in Brazil [ 24 ], CEAs conducted in the Brazilian context of neglected diseases have adopted interventions with ICERs up to one Brazilian GDP per capita for each additional unit of the health effect, including: hospitalization averted [ 19 ], days of hospitalisation avoided [ 25 ], case averted [ 26 ], and cure [ 27 ]. These outcomes are natural units that are intuitively understood in the health care field, facilitating decision making [ 28 ].…”

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“…Sendo os maiores custos aqueles relacionados com a triagem sorológica da infecção por TR-DPP e ELISA (R$ 20,32) e o sacrifício dos cães reagentes (R$ 459,00). O custo da coleira Scalibor® tamanho grande (65cm), substituída a cada 6 meses foi estimado em R$ 11,97, considerando que, em média, duas coleiras contemplavam em 3 animais (ASSIS et al, 2020). A eutanásia de cães soropositivos, por ser uma medida drástica e contrária a princípios gerais do direito dos animais, é muito questionada e combatida, com evidente aumento nas recusas de entrega do cão soropositivo para a eutanásia e para colheita de sangue de cães nos inquéritos sorológicos caninos.…”

“…Esses resultados indicam ainda que o encoleiramento de todos os cães de uma área de transmissão, independentemente da execução prévia de inquérito sorológico, poderia ser uma estratégia custo-efetiva, uma vez que, de acordo com os resultados obtidos por Assis et al (2020), os maiores custos da estratégia convencional de controle da LV estão relacionados com o diagnóstico e procedimentos envolvidos na eutanásia dos cães reagentes. Assim, sugerimos que estudos adicionais sejam elaborados nesse sentido.…”