Cost-effectiveness analysis of Mucosal Leishmaniasis diagnosis with PCR-based vs parasitological tests in Colombia

Autor: Guillermo Sánchez-Vanegas, Sandra Muvdi-Arenas, Clemencia Ovalle-Bracho, Liliana Castillo-Rodríguez, Diana Díaz-Jiménez, Carlos Castañeda-Orjuela
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Leishmaniasis
Mucocutaneous
Pediatrics
Economics
Biopsy
Cost-Benefit Analysis
Social Sciences
Pathology and Laboratory Medicine
Polymerase Chain Reaction
Geographical locations
0302 clinical medicine
Zoonoses
Per capita
Medicine and Health Sciences
Prevalence
Medicine
Mucosal leishmaniasis
030212 general & internal medicine
Leishmaniasis
health care economics and organizations
Leishmania
Multidisciplinary
Cost–benefit analysis
Cost-effectiveness analysis
Health Care Costs
Infectious Diseases
Models
Economic
Quality-Adjusted Life Years
Research Article
Neglected Tropical Diseases
Adult
medicine.medical_specialty
Science
030231 tropical medicine
Cost-Effectiveness Analysis
Surgical and Invasive Medical Procedures
Colombia
03 medical and health sciences
Health Economics
Signs and Symptoms
Life Expectancy
Willingness to pay
Diagnostic Medicine
Parasitic Diseases
Humans
Health economics
Protozoan Infections
Mucous Membrane
business.industry
Diagnostic Tests
Routine
Biology and Life Sciences
South America
Tropical Diseases
Economic Analysis
Quality-adjusted life year
Health Care
Life expectancy
Lesions
Parasitology
People and places
business
Zdroj: PLoS ONE
PLoS ONE, Vol 14, Iss 11, p e0224351 (2019)
ISSN: 1932-6203
Popis: To estimate the cost-effectiveness of available diagnosis alternatives for Mucosal Leishmaniasis (ML) in Colombian suspected patients. A simulation model of the disease's natural history was built with a decision tree and Markov models. The model´s parameters were identified by systematic review and validated by expert consensus. A bottom-up cost analysis to estimate the costs of diagnostic strategies and treatment per case was performed by reviewing 48 clinical records of patients diagnosed with ML. The diagnostic strategies compared were as follows: 1) no diagnosis; 2) parasite culture, biopsy, indirect immunofluorescence assay (IFA), and Montenegro skin test (MST) combined ; 3) parasite culture, biopsy, and IFA combined; 4) PCR-miniexon; and 5) PCR-kDNA. Three scenarios were modeled in patients with ML clinical suspicion, according to ML prevalence scenarios: high, medium and low. Adjusted sensitivity and specificity parameters of a combination of diagnostic tests were estimated with a discrete event simulation (DES) model. For each alternative, the costs and health outcomes were estimated. The time horizon was life expectancy, considering the average age at diagnosis of 31 years. Incremental cost-effectiveness ratios (ICERs) were calculated per Disability Life Year (DALY) avoided, and deterministic and probabilistic sensitivity analyses were performed. A threshold of willingness to pay (WTP) of three-time gross domestic product per capita (GDPpc) (US$ 15,795) and a discount rate of 3% was considered. The analysis perspective was the third payer (Health System). All costs were reported in American dollars as of 2015. PCR- kDNA was the cost-effective alternative in clinical suspicion levels: low, medium and high with ICERs of US$ 7,909.39, US$ 5,559.33 and US$ 4,458.92 per DALY avoided, respectively. ML diagnostic tests based on PCR are cost-effective strategies, regardless of the level of clinical suspicion. PCR-kDNA was the most cost-effective strategy in the competitive scenario with the parameters included in the present model.
Databáze: OpenAIRE
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