Cost-effectiveness and social outcomes of a community-based treatment for podoconiosis lymphoedema in the East Gojjam zone, Ethiopia

Abstract

BackgroundPodoconiosis is a disease of the lymphatic vessels of the lower extremities that is caused by chronic exposure to irritant soils. It results in leg swelling, commonly complicated by acute dermatolymphangioadenitis (ADLA), characterised by severe pain, fever and disability.MethodsWe conducted cost-effectiveness and social outcome analyses of a pragmatic, randomised controlled trial of a hygiene and foot-care intervention for people with podoconiosis in the East Gojjam zone of northern Ethiopia. Participants were allocated to the immediate intervention group or the delayed intervention group (control). The 12-month intervention included training in foot hygiene, skin care, bandaging, exercises, and use of socks and shoes, and was supported by lay community assistants. The cost-effectiveness analysis was conducted using the cost of productivity loss due to acute dermatolymphangioadenitis. Household costs were not included. Health outcomes in the cost-effectiveness analysis were: the incidence of ADLA episodes, health-related quality of life captured using the Dermatology Life Quality Index (DLQI), and disability scores measured using the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0).ResultsThe cost of the foot hygiene and lymphoedema management supplies was 529 ETB (69 I$, international dollars) per person per year. The cost of delivery of the intervention as part of the trial, including transportation, storage, training of lay community assistants and administering the intervention was 1,890 ETB (246 I$) per person. The intervention was effective in reducing the incidence of acute dermatolymphangioadenitis episodes and improving DLQI scores, while there were no significant improvements in the disability scores measured using WHODAS 2.0. In 75% of estimations, the intervention was less costly than the control. This was due to improved work productivity. Subgroup analyses based on income group showed that the intervention was cost-effective (both less costly and more effective) in reducing the number of acute dermatolymphangioadenitis episodes and improving health-related quality of life in families with monthly income <1,000 ETB (130 I$). For the subgroup with family income ≥1,000 ETB, the intervention was more effective but more costly than the control.ConclusionsWhilst there is evident benefit of the intervention for all, the economic impact would be greatest for the poorest.

Economic assessment of a community-based care package for people with lower limb disorder caused by lymphatic filariasis, podoconiosis and leprosy in Ethiopia

“…The cost of delivering the intervention to patients was 1890 ETB per person and the cost of healthcare supplies was 529 ETB per person. 5 However, the GoLBeT study did not show an improvement in disability, also measured using the WHODAS 2.0. There are several explanations for recording an impact on disability within EnDPoINT, but not within GoLBeT.…”

“…Previously the effectiveness of a community-based physical care package for people with podoconiosis was demonstrated in the Gojjam Lymphoedema Best Practice Trial (GoLBeT), which was conducted in northern Ethiopia. 5 The 12-month GoLBeT intervention included training in foot hygiene, skin care, bandaging, exercises and the use of socks and shoes, supported by lay community assistants. The study showed a decrease in the incidence of ADLA episodes and days off work due to disability and an improvement in dermatologic quality of life captured using the DLQI.…”

“…These numbers are in line with our findings from the GoLBeT trial, where the cost of care supplies was 529 ETB per person, including shoes. 5 It should be mentioned that a large proportion of the implementation costs are incurred upfront, therefore the cost of the intervention will decrease when the healthcare package is fully adopted. Our future scale-up study in three other districts in northwest Ethiopia will provide more information on costs and cost-effectiveness of the care package.…”

“…Daily home-based hygiene self-care has been shown to reduce swelling and ADLA in resource-poor settings. 5 , 6 , 9–11 This involves daily washing and drying of affected limbs, applying ointment, bandaging, passive range of motion exercises, elevation of the affected limbs overnight and whenever possible during the day and wearing socks and shoes. In the past two decades in Ethiopia, foot hygiene treatment has been offered to people with lymphoedema mainly via non-government organisations, 12 , 13 without state adoption or integration into routine primary care.…”

Addition of Lymphatic Stimulating Self-Care Practices Reduces Acute Attacks among People Affected by Moderate and Severe Lower-Limb Lymphedema in Ethiopia, a Cluster Randomized Controlled Trial

“…The World Health Organization (WHO) provides guidelines for LF endemic countries to carry out the morbidity management and disability prevention (MMDP) aspects of the GPELF [ 2 ], and recommend the same guidelines be used to support people affected by podoconiosis-related lymphedema [ 3 ]. LF and podoconiosis are co-endemic in 20 countries [ 4 ] and in both cases the burden of disability occurs disproportionately among the poorest populations [ 5 , 6 ] and the most severe cases require considerable family and community support [ 7 ]. The GPELF has been successful in stopping LF transmission in 17 of 72 endemic countries [ 8 ], so there should be no new cases of LF-related lymphedema in those countries.…”