1
|
Kaye PM, Matlashewski G, Mohan S, Le Rutte E, Mondal D, Khamesipour A, Malvolti S. Vaccine value profile for leishmaniasis. Vaccine 2023; 41 Suppl 2:S153-S175. [PMID: 37951693 DOI: 10.1016/j.vaccine.2023.01.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/22/2022] [Accepted: 01/24/2023] [Indexed: 11/14/2023]
Abstract
Leishmania infections are global, occurring in 98 countries and all World Health Organization (WHO) regions with 600 million to 1 billion people at risk of infection. Visceral leishmaniasis is associated with almost 20,000 reported deaths annually, with children under 5 years of age being at the greatest risk of mortality. Amongst WHO-recognised Neglected Tropical Diseases (NTDs), leishmaniasis is one of the most important in terms of mortality and morbidity. With an increasing global burden of disease and a growing threat from climate change, urbanisation and drug resistance, there remains an imperative to develop leishmaniasis vaccines. New tools to understand correlates of protection and to assess vaccine efficacy are being developed to ease the transition into larger scale efficacy trials or provide alternate routes to licensure. Early indications suggest a diverse portfolio of manufacturers exists in endemic countries with an appetite to develop leishmaniasis vaccines. This Vaccine Value Profile (VVP) provides a high-level, comprehensive assessment of the currently available data to inform the potential public health, economic, and societal value of leishmaniasis vaccines. The leishmaniasis VVP was developed by a working group of subject matter experts from academia, public health groups, policy organizations, and non-profit organizations. All contributors have extensive expertise on various elements of the leishmaniasis VVP and have collectively described the state of knowledge and identified the current gaps. The VVP was developed using only existing and publicly available information.
Collapse
Affiliation(s)
- Paul M Kaye
- York Biomedical Research Institute, Hull York Medical School, University of York, York, UK.
| | - Greg Matlashewski
- Department of Microbiology and Immunology, McGill University, Montreal, Quebec, Canada.
| | - Sakshi Mohan
- Center for Health Economics (CHE), University of York, York, UK.
| | - Epke Le Rutte
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Dinesh Mondal
- Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
| | - Ali Khamesipour
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran.
| | | |
Collapse
|
2
|
Geber Júnior JC, Monteiro RADA, Rocha JWPD, Duarte ELT, Nicodemo E, Munhoz O, Paiva EFD, Mauad T, Silva LFFD, Saldiva PHN, Dolhnikoff M, Duarte-Neto AN. What else in times of COVID-19? The role of minimally invasive autopsy for the differential diagnosis of acute respiratory failure in a case of kala-azar. Rev Inst Med Trop Sao Paulo 2023; 65:e36. [PMID: 37283411 DOI: 10.1590/s1678-9946202365036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/20/2023] [Indexed: 06/08/2023] Open
Abstract
Visceral leishmaniasis (VL) is a chronic vector-borne zoonotic disease caused by trypanosomatids, considered endemic in 98 countries, mainly associated with poverty. About 50,000-90,000 cases of VL occur annually worldwide, and Brazil has the second largest number of cases in the world. The clinical picture of VL is fever, hepatosplenomegaly, and pancytopenia, progressing to death in 90% of cases due to secondary infections and multi-organ failure, if left untreated. We describe the case of a 25-year-old female who lived in the metropolitan area of Sao Paulo, who had recently taken touristic trips to several rural areas in Southeastern Brazil and was diagnosed post-mortem. During the hospitalization in a hospital reference for the treatment of COVID-19, the patient developed acute respiratory failure, with chest radiographic changes, and died due to refractory shock. The ultrasound-guided minimally invasive autopsy diagnosed VL (macrophages containing amastigote forms of Leishmania in the spleen, liver and bone marrow), as well as pneumonia and bloodstream infection by gram-negative bacilli.
Collapse
Affiliation(s)
- João Carlos Geber Júnior
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Clínica Médica, São Paulo, São Paulo, Brazil
| | | | - João Wilson Pedro da Rocha
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Clínica Médica, São Paulo, São Paulo, Brazil
| | - Edson Luiz Társia Duarte
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Moléstias Infecciosas e Transmissíveis, São Paulo, São Paulo, Brazil
| | - Elizabete Nicodemo
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Moléstias Infecciosas e Transmissíveis, São Paulo, São Paulo, Brazil
| | - Olavo Munhoz
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Moléstias Infecciosas e Transmissíveis, São Paulo, São Paulo, Brazil
| | - Edison Ferreira de Paiva
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Clínica Médica, São Paulo, São Paulo, Brazil
| | - Thais Mauad
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia, São Paulo, São Paulo, Brazil
| | | | | | - Marisa Dolhnikoff
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia, São Paulo, São Paulo, Brazil
| | - Amaro Nunes Duarte-Neto
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Patologia, São Paulo, São Paulo, Brazil
| |
Collapse
|
3
|
Brito SPDS, Lima MDS, Ferreira AF, Ramos AN. [Hospital admissions due to neglected tropical diseases in Piauí, in the Northeast region of Brazil: costs, time trends, and spatial patterns, 2001-2018]. CAD SAUDE PUBLICA 2022; 38:e00281021. [PMID: 36169444 DOI: 10.1590/0102-311xpt281021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 07/01/2022] [Indexed: 11/22/2022] Open
Abstract
To characterize the magnitude of hospital admissions and costs of patients with neglected tropical diseases, their time trends, and spatial patterns in Piauí, in the Northeast Region of Brazil, in 2001-2018. Ecological study of mixed designs, with calculation of relative risk (RR), time-trend analysis by Poisson regression, and inflection points, using data from neglected tropical diseases Hospital Admission Authorizations available in the Hospital Information System of the Brazilian Unified National Health System (SIH/SUS). Data showed 49,832 hospital admissions due to neglected tropical diseases in the period (rate: 86.70/100,000 inhabitants; 95%CI: 83.47; 89.93); of these, dengue (78.2%), leishmaniasis (8.6%), and leprosy (6.4%). The total cost was BRL 34,481,815.43, 42.8% of which referred to medium complexity cases. Higher risks of hospitalization occurred among people ≥ 60 years (RR = 1.8; 95%CI: 1.5; 2.2), mixed race/color (RR = 1.7; 95%CI: 1.1; 2.4), residents of municipalities presenting medium social vulnerability (RR = 1.5; 95% CI: 1.3; 1.6), and population size (RR = 1.6; 95%CI: 1.4; 1.9). The time trend showed a reduction in hospital admissions due to neglected tropical diseases, 2003-2018 (annual percent change - APC: -10.3; 95%CI: -14.7; -5.6). The spatial pattern showed clusters with higher rates of hospital admission in border municipalities located south of the Mid-north macroregion, north of the Semiarid macroregion, and south of the Cerrados macroregion. Piauí remains with high hospital admission rates and costs for neglected tropical diseases. Despite the reduction in time trends, knowledge burden, population groups, and municipalities at greater risk and vulnerability reinforce the importance of monitoring and strengthening control actions to maintain the reduction of the burden and costs of hospital admission due to neglected tropical diseases in the state.
Collapse
Affiliation(s)
- Sheila Paloma de Sousa Brito
- Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, Brasil.,Coordenação de Sistemas de Informação, Universidade Federal do Piauí, Picos, Brasil
| | | | | | | |
Collapse
|
4
|
Estimating the global demand curve for a leishmaniasis vaccine: A generalisable approach based on global burden of disease estimates. PLoS Negl Trop Dis 2022; 16:e0010471. [PMID: 35696433 PMCID: PMC9232160 DOI: 10.1371/journal.pntd.0010471] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 06/24/2022] [Accepted: 05/05/2022] [Indexed: 11/19/2022] Open
Abstract
Background
A pressing need exists to develop vaccines for neglected diseases, including leishmaniasis. However, the development of new vaccines is dependent on their value to two key players–vaccine developers and manufacturers who need to have confidence in the global demand in order to commit to research and production; and governments (or other international funders) who need to signal demand based on the potential public health benefits of the vaccine in their local context, as well as its affordability. A detailed global epidemiological analysis is rarely available before a vaccine enters a market due to lack of resources as well as insufficient global data necessary for such an analysis. Our study seeks to bridge this information gap by providing a generalisable approach to estimating the commercial and public health value of a vaccine in development relying primarily on publicly available Global Burden of Disease (GBD) data. This simplified approach is easily replicable and can be used to guide discussions and investments into vaccines and other health technologies where evidence constraints exist. The approach is demonstrated through the estimation of the demand curve for a future leishmaniasis vaccine.
Methodology/Principal findings
We project the ability to pay over the period 2030–2040 for a vaccine preventing cutaneous and visceral leishmaniasis (CL / VL), using an illustrative set of countries which account for most of the global disease burden. First, based on previous work on vaccine demand projections in these countries and CL / VL GBD-reported incidence rates, we project the potential long-term impact of the vaccine on disability-adjusted life years (DALYs) averted as a result of reduced incidence. Then, we apply an economic framework to our estimates to determine vaccine affordability based on the abilities to pay of governments and global funders, leading to estimates of the demand and market size. Based on our estimates, the maximum ability-to-pay of a leishmaniasis vaccine (per course, including delivery costs), given the current estimates of incidence and population at risk, is higher than $5 for 25–30% of the countries considered, with the average value-based maximum price, weighted by quantity demanded, being $5.7–6 [$0.3 - $34.5], and total demand of over 560 million courses.
Conclusion/Significance
Our results demonstrate that both the quantity of vaccines estimated to be required by the countries considered as well as their ability-to-pay could make a vaccine for leishmaniasis commercially attractive to potential manufacturers. The methodology used can be equally applied to other technology developments targeting health in developing countries.
Collapse
|
5
|
Kaye PM, Mohan S, Mantel C, Malhame M, Revill P, Le Rutte E, Parkash V, Layton AM, Lacey CJ, Malvolti S. Overcoming roadblocks in the development of vaccines for leishmaniasis. Expert Rev Vaccines 2021; 20:1419-1430. [PMID: 34727814 PMCID: PMC9844205 DOI: 10.1080/14760584.2021.1990043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/04/2021] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The leishmaniases represent a group of parasitic diseases caused by infection with one of several species of Leishmania parasites. Disease presentation varies because of differences in parasite and host genetics and may be influenced by additional factors such as host nutritional status or co-infection. Studies in experimental models of Leishmania infection, vaccination of companion animals and human epidemiological data suggest that many forms of leishmaniasis could be prevented by vaccination, but no vaccines are currently available for human use. AREAS COVERED We describe some of the existing roadblocks to the development and implementation of an effective leishmaniasis vaccine, based on a review of recent literature found on PubMed, BioRxiv and MedRxiv. In addition to discussing scientific unknowns that hinder vaccine candidate identification and selection, we explore gaps in knowledge regarding the commercial and public health value propositions underpinning vaccine development and provide a route map for future research and advocacy. EXPERT OPINION Despite significant progress, leishmaniasis vaccine development remains hindered by significant gaps in understanding that span the vaccine development pipeline. Increased coordination and adoption of a more holistic view to vaccine development will be required to ensure more rapid progress in the years ahead.
Collapse
Affiliation(s)
- Paul M. Kaye
- York Biomedical Research Institute, Hull York Medical School, University of York, Heslington, York, UK
| | - Sakshi Mohan
- Centre for Health Economics, University of York, Heslington, York, UK
| | | | | | - Paul Revill
- Centre for Health Economics, University of York, Heslington, York, UK
| | - Epke Le Rutte
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vivak Parkash
- York Biomedical Research Institute, Hull York Medical School, University of York, Heslington, York, UK
| | - Alison M. Layton
- York Biomedical Research Institute, Hull York Medical School, University of York, Heslington, York, UK
| | - Charles J.N. Lacey
- York Biomedical Research Institute, Hull York Medical School, University of York, Heslington, York, UK
| | | |
Collapse
|
6
|
Grifferty G, Shirley H, McGloin J, Kahn J, Orriols A, Wamai R. Vulnerabilities to and the Socioeconomic and Psychosocial Impacts of the Leishmaniases: A Review. Res Rep Trop Med 2021; 12:135-151. [PMID: 34188584 PMCID: PMC8236266 DOI: 10.2147/rrtm.s278138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/06/2021] [Indexed: 11/23/2022] Open
Abstract
The leishmaniases are a group of four vector-borne neglected tropical diseases (NTDs) with 1.6 billion people in some 100 countries at risk. They occur in certain eco-epidemiological foci that reflect manipulation by human activities, such as migration, urbanization and deforestation, of which poverty, conflict and climate change are key drivers. Given their synergistic impacts, risk factors and the vulnerabilities of poor populations and the launch of a new 2030 roadmap for NTDs in the context of the global sustainability agenda, it is warranted to update the state of knowledge of the leishmaniases and their effects. Using existing literature, we review socioeconomic and psychosocial impacts of leishmaniasis within a framework of risk factors and vulnerabilities to help inform policy interventions. Studies show that poverty is an overarching primary risk factor. Low-income status fosters inadequate housing, malnutrition and lack of sanitation, which create and exacerbate complexities in access to care and treatment outcomes as well as education and awareness. The co-occurrence of the leishmaniases with malnutrition and HIV infection further complicate diagnosis and treatment, leading to poor diagnostic outcomes and therapeutic response. Even with free treatment, households may suffer catastrophic health expenditure from direct and indirect medical costs, which compounds existing financial strain in low-income communities for households and healthcare systems. The dermatological presentations of the leishmaniases may result in long-term severe disfigurement, leading to stigmatization, reduced quality of life, discrimination and mental health issues. A substantial amount of recent literature points to the vulnerability pathways and burden of leishmaniasis on women, in particular, who disproportionately suffer from these impacts. These emerging foci demonstrate a need for continued international efforts to address key risk factors and population vulnerabilities if leishmaniasis control, and ultimately elimination, is to be achieved by 2030.
Collapse
Affiliation(s)
- Grace Grifferty
- Department of Biology, Northeastern University, College of Science, Boston, MA, USA
| | - Hugh Shirley
- Department of Biochemistry, Northeastern University, College of Science, Boston, MA, USA.,Program in Medical Education, Harvard Medical School, Boston, MA, USA
| | - Jamie McGloin
- Department of Health Sciences, Northeastern University, Bouvé College of Health Sciences, Boston, MA, USA
| | - Jorja Kahn
- Department of Behavioral Neuroscience, Northeastern University, College of Science, Boston, MA, USA
| | - Adrienne Orriols
- Department of Behavioral Neuroscience, Northeastern University, College of Science, Boston, MA, USA
| | - Richard Wamai
- Department of Cultures, Societies and Global Studies, Northeastern University, College of Social Sciences and Humanities, Integrated Initiative for Global Health, Boston, MA, USA
| |
Collapse
|
7
|
Assis TMD, Rabello A, Cota G. Economic evaluations addressing diagnosis and treatment strategies for neglected tropical diseases: an overview. Rev Inst Med Trop Sao Paulo 2021; 63:e41. [PMID: 34037157 PMCID: PMC8149103 DOI: 10.1590/s1678-9946202163041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/23/2021] [Indexed: 11/22/2022] Open
Abstract
Neglected tropical diseases (NTDs) are those affecting vulnerable people and
causing additional social and economic burden. The aim of this study was to
carry out a general overview of the health economic assessments involving the
diagnosis and treatment of six NTDs: cutaneous leishmaniasis (CL), Chagas
disease, cysticercosis, filariasis, schistosomiasis and visceral leishmaniasis
(VL). The literature search was based on two of the main medical literature
databases (Medline and SciELO) and identified 46 studies. Twenty-six studies
(57%) addressed therapeutic strategies, while other 20 (43%) assessed diagnostic
or both diagnostic and therapeutic approaches. The studies were published
between 1994 and 2021, and 57% of them (26/46) were carried out in four
countries. Cost-effectiveness analyses were conducted in 59% (27/46) of the
studies. Economic studies of NTDs have timidly increased in recent years.
Despite the improvement of analytical methods, completeness and accuracy of
information, there are few new technologies applied to NTDs and public health
systems. In addition, economic studies for NTDs are concentrated in a few
countries. Thus, this review points out the need for investment in research,
development and training of human resources dedicated to the economic analysis
in health, especially on NTDs, as a strategy to reduce inequalities by
optimizing the use of health resources.
Collapse
Affiliation(s)
- Tália Machado de Assis
- Fundação Oswaldo Cruz, Instituto René Rachou, Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, Minas Gerais, Brazil.,Centro Federal de Educação Tecnológica de Minas Gerais, Contagem, Minas Gerais, Brazil
| | - Ana Rabello
- Fundação Oswaldo Cruz, Instituto René Rachou, Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, Minas Gerais, Brazil
| | - Gláucia Cota
- Fundação Oswaldo Cruz, Instituto René Rachou, Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
8
|
Borges LM, Oliveira AGD, Mateus NLF, de Oliveira EF, Arrua AEC, Infran JDOM, Taketa LB, Monteiro PEDO, Fernandes CEDS, Piranda EM. Canine Visceral Leishmaniasis in an Area of Sporadic Transmission in Brazil. Vector Borne Zoonotic Dis 2021; 21:539-545. [PMID: 34030472 DOI: 10.1089/vbz.2020.2701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Canine visceral leishmaniasis is a zoonotic disease caused by the protozoan Leishmania infantum in Latin America. Visceral leishmaniasis (VL) diagnosis in Brazil includes two serological tests according to the Ministry of Health (MH) protocol. Sensitivity and specificity of diagnostic tests, as well as clinical signs of VL, are usually reported in disease-endemic areas; however, it is known that local epidemiological factors can influence these results. This study aimed to evaluate the clinical features, sensitivity, and specificity of TR-DPP® and EIE-LVC in naturally infected dogs in a region of sporadic VL transmission to humans in Brazil. A total of 288 dogs were clinically evaluated and serological and parasitological (lymph node aspirates) samples were collected for VL diagnosis. TR-DPP and EIE-LVC showed poor sensitivity (0.62 and 0.44, respectively) to detect infected animals, compared with the direct parasitological examination, which is considered a gold standard method. Thus, the protocol of MH presented low sensitivity (0.42) to estimate prevalence and control measures in this region. TR-DPP presented a high negative predictive value (0.89), resulting in its indication as a confirmatory test in sporadic transmission areas. Classical clinical signs of VL were not frequently observed; therefore, clinical scoring systems might not be useful in this region. Veterinarians of nonendemic areas should be alert for asymptomatic dogs, especially those presenting lymph adenomegaly.
Collapse
Affiliation(s)
- Leandro Machado Borges
- Secretaria Municipal de Saúde de Camapuã/MS - Setor de Zoonoses, Mato Grosso do Sul, Brasil.,Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Mato Grosso do Sul, Brasil
| | - Alessandra Gutierrez de Oliveira
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Mato Grosso do Sul, Brasil.,Laboratório de Parasitologia Humana, Instituto de Biociências, Universidade Federal de Mato Grosso do Sul, Mato Grosso do Sul, Brasil
| | - Nathália Lopes Fontoura Mateus
- Programa de Pós-Graduação em Ciências Veterinárias, Faculdade de Medicina Veterinária e Zootecnia, Universidade Federal de Mato Grosso do Sul, Mato Grosso do Sul, Brasil
| | - Everton Falcão de Oliveira
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Mato Grosso do Sul, Brasil.,Instituto Integrado de Saúde, Universidade Federal de Mato Grosso do Sul, Mato Grosso do Sul, Brasil
| | - Aline Etelvina Casaril Arrua
- Laboratório de Parasitologia Humana, Instituto de Biociências, Universidade Federal de Mato Grosso do Sul, Mato Grosso do Sul, Brasil
| | - Jucelei de Oliveira Moura Infran
- Laboratório de Parasitologia Humana, Instituto de Biociências, Universidade Federal de Mato Grosso do Sul, Mato Grosso do Sul, Brasil
| | - Lucas Bezerra Taketa
- Programa de Iniciação Científica (PIBIC), Universidade Federal de Mato Grosso do Sul, Mato Grosso do Sul, Brasil
| | | | | | - Eliane Mattos Piranda
- Laboratório de Parasitologia Humana, Instituto de Biociências, Universidade Federal de Mato Grosso do Sul, Mato Grosso do Sul, Brasil
| |
Collapse
|
9
|
Carvalho JDP, de Assis TM, Simões TC, Cota G. Estimating direct costs of the treatment for mucosal leishmaniasis in Brazil. Rev Soc Bras Med Trop 2021; 54:e04542020. [PMID: 33533816 PMCID: PMC7849328 DOI: 10.1590/0037-8682-0454-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/15/2020] [Indexed: 04/01/2024] Open
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.
Collapse
Affiliation(s)
- Janaína de Pina Carvalho
- Fundação Oswaldo Cruz, Instituto René Rachou, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, MG, Brasil
| | - Tália Machado de Assis
- Fundação Oswaldo Cruz, Instituto René Rachou, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, MG, Brasil
- Centro Federal de Educação Tecnológica de Minas Gerais, Campus Contagem, Contagem, MG, Brasil
| | - Taynãna César Simões
- Fundação Oswaldo Cruz, Instituto René Rachou, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, MG, Brasil
| | - Gláucia Cota
- Fundação Oswaldo Cruz, Instituto René Rachou, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, MG, Brasil
| |
Collapse
|
10
|
Silva Ferreira de Carvalho IP, Peixoto HM, Sierra Romero GA, Fernandes de Oliveira MR. Treatment With Liposomal Amphotericin B for All Confirmed Cases of Human Visceral Leishmaniasis in Brazil: A Budget Impact Analysis. Value Health Reg Issues 2020; 23:77-84. [PMID: 32961526 DOI: 10.1016/j.vhri.2020.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 03/12/2020] [Accepted: 05/28/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To estimate the budget impact of the expansion of liposomal amphotericin B use for all confirmed cases of visceral leishmaniasis (VL) in Brazil. Currently, the first-line medicine for VL treatment is meglumine antimoniate. Liposomal amphotericin B is indicated only for patients with a greater risk of severity by the disease. METHODS The analysis was performed from the perspective of the Brazilian public healthcare system over 3 years, considering the following 2 scenarios: the reference scenario with the current recommendations for VL treatment and the alternative scenario based on the use of liposomal amphotericin B for all patients. A diffusion rate of 60% was used in the first year, 80% in the second year, and 100% in the third year. The epidemiological parameters used in the analysis came from the Notifiable Diseases Information System and from a clinical trial that evaluated the efficacy and safety of medicines for the treatment of VL in the country. The costs were related to the treatment of VL and to hospital and outpatient care. RESULTS In the reference scenario, the total cost for treatment of the 3453 VL confirmed cases in 2014 was $1 447 611.75. The incremental budget impact with the use of liposomal amphotericin B for all the VL confirmed cases was $299 646.43 in the third year. CONCLUSIONS The analysis presented will support the decision process for the use and expansion of liposomal amphotericin B for all VL confirmed cases in Brazil.
Collapse
Affiliation(s)
| | - Henry Maia Peixoto
- Centre for Tropical Medicine, University of Brasilia, Brasilia, Federal District, Brazil; National Institute for Science and Technology for Health Technology Assessment, Porto Alegre, RS, Brazil
| | - Gustavo Adolfo Sierra Romero
- Centre for Tropical Medicine, University of Brasilia, Brasilia, Federal District, Brazil; National Institute for Science and Technology for Health Technology Assessment, Porto Alegre, RS, Brazil
| | - Maria Regina Fernandes de Oliveira
- Centre for Tropical Medicine, University of Brasilia, Brasilia, Federal District, Brazil; National Institute for Science and Technology for Health Technology Assessment, Porto Alegre, RS, Brazil
| |
Collapse
|
11
|
Freire ML, de Souza A, Cota G, Rabello A, Machado de Assis T. Cost-effectiveness of serological tests for human visceral leishmaniasis in the Brazilian scenario. PLoS Negl Trop Dis 2020; 14:e0008741. [PMID: 33031382 PMCID: PMC7544087 DOI: 10.1371/journal.pntd.0008741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 08/24/2020] [Indexed: 11/18/2022] Open
Abstract
Human visceral leishmaniasis (VL) is a severe and potentially fatal parasitic disease if not correctly diagnosed and treated. Brazil is one of the three countries most endemic for VL and, like most countries affected by this disease, has a large budget constraint for the incorporation of new health technologies. Although different diagnostic tests for VL are currently available in the country, economic studies evaluating diagnostic kits are scarce. The objective of this study was to conduct a cost-effectiveness analysis of the nine available diagnostic tests for human VL in HIV-infected and uninfected patients in Brazil. The perspective of analysis was the Brazilian public health system, and the outcome of interest was "cases diagnosed correctly". The costs of the tests were estimated using the microcosting technique, and comparisons were performed with decision trees. Sensitivity analyses were explored applying variations in cost and effectiveness values. For VL diagnosis among HIV-uninfected patients, using blood samples for the rapid tests (RDTs), the noncommercial direct agglutination test (DAT-LPC) and IT-LEISH were cost-effective tests compared with the baseline OnSite test, but they presented different incremental cost-effectiveness ratios (ICER) of US$7.04 and US$ 205.40, respectively. Among HIV-infected patients, DAT-LPC was the most cost-effective diagnostic test. Comparisons among the tests with the same methodology, based on the low ICER values, revealed that IT-LEISH was the most cost-effective test among the RDTs and the Ridascreen Leishmania Ab among the ELISA tests. These results confirm that cost-effectiveness analyses can provide useful information to support the incorporation of new health technologies within a known scenario and willingness to pay threshold. It was observed that tests based on the same methodologies presented different cost-effectiveness ratios for the same group of patients and that different tests should be recommended for different patient groups. DAT-LPC was an important cost-effective strategy for all patients, requiring minimum laboratorial infrastructure, and IT-LEISH was the cost-effective test for VL screening in HIV-uninfected patients. IT-LEISH and DAT-LPC have complementary profiles and should both be provided by the Brazilian health system.
Collapse
Affiliation(s)
- Mariana Lourenço Freire
- Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Barro Preto, Belo Horizonte, Minas Gerais, Brasil
| | - Aline de Souza
- Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Barro Preto, Belo Horizonte, Minas Gerais, Brasil
| | - Gláucia Cota
- Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Barro Preto, Belo Horizonte, Minas Gerais, Brasil
| | - Ana Rabello
- Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Barro Preto, Belo Horizonte, Minas Gerais, Brasil
| | - Tália Machado de Assis
- Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Barro Preto, Belo Horizonte, Minas Gerais, Brasil
- Centro Federal de Educação Tecnológica de Minas Gerais, Campus Contagem, Alameda das Perdizes, Cabral, Contagem, Minas Gerais, Brasil
| |
Collapse
|
12
|
Sevá ADP, Ferreira F, Amaku M. How much does it cost to prevent and control visceral leishmaniasis in Brazil? Comparing different measures in dogs. PLoS One 2020; 15:e0236127. [PMID: 32692783 PMCID: PMC7373293 DOI: 10.1371/journal.pone.0236127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 06/29/2020] [Indexed: 11/19/2022] Open
Abstract
Visceral leishmaniasis (VL) is an important zoonosis in Brazil. Dogs are considered the main domestic reservoirs of the disease in the country; hence, control measures are focused on these reservoirs. Despite efforts to prevent and control VL, important reductions in disease prevalence and incidence have not been identified, stimulating the development and application of new strategies. The choice and implementation of new control strategies can benefit from the application of mathematical models that allow the simulation of different strategies in different scenarios. Selecting the best strategy to be implemented is also supported by cost-effectiveness studies. Here we used the results of a mathematical model in which scenarios, including isolated use of the vaccine and insecticide-impregnated collar (IIC), both at different coverage rates, were simulated to conduct a cost-effectiveness study. The costs were calculated for each scenario considering a simulation period of four years. Collar application in both infected and non-infected animals was the most cost-effective strategy. For example, to reduce the prevalence in humans and dogs by approximately 70%, the costs ranged from $250,000 and $550,000 for the IICs and vaccination, respectively. Even in the scenario with 40% loss/replacement of IICs, this measure was more advantageous in terms of cost-effectiveness than vaccination. If the vaccine were applied with culling of seropositive tested dogs, then the measure became more effective with a reduced cost compared with the vaccine alone. The use of the three first consecutive vaccine doses had the greatest impact on the cost of the vaccination strategy. The advantage of using IICs is that there is no need for a prior diagnosis, unlike vaccination, reducing costs and facilitating implementation. The present study aims to contribute to strategies to reduce hosts infected with VL by reducing public expenditure.
Collapse
Affiliation(s)
- Anaiá da Paixão Sevá
- Department of Animal Health and Preventive Veterinary, University of São Paulo, São Paulo, São Paulo, Brazil
- Department of Exact and Technological Sciences, State University of Santa Cruz, Ilhéus, Brazil
- * E-mail: ,
| | - Fernando Ferreira
- Department of Animal Health and Preventive Veterinary, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Marcos Amaku
- Department of Animal Health and Preventive Veterinary, University of São Paulo, São Paulo, São Paulo, Brazil
| |
Collapse
|
13
|
Servadio JL, Machado G, Alvarez J, de Ferreira Lima Júnior FE, Vieira Alves R, Convertino M. Information differences across spatial resolutions and scales for disease surveillance and analysis: The case of Visceral Leishmaniasis in Brazil. PLoS One 2020; 15:e0235920. [PMID: 32678864 PMCID: PMC7367469 DOI: 10.1371/journal.pone.0235920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/25/2020] [Indexed: 12/26/2022] Open
Abstract
Nationwide disease surveillance at a high spatial resolution is desired for many infectious diseases, including Visceral Leishmaniasis. Statistical and mathematical models using data collected from surveillance activities often use a spatial resolution and scale either constrained by data availability or chosen arbitrarily. Sensitivity of model results to the choice of spatial resolution and scale is not, however, frequently evaluated. This study aims to determine if the choice of spatial resolution and scale are likely to impact statistical and mathematical analyses. Visceral Leishmaniasis in Brazil is used as a case study. Probabilistic characteristics of disease incidence, representing a likely outcome in a model, are compared across spatial resolutions and scales. Best fitting distributions were fit to annual incidence from 2004 to 2014 by municipality and by state. Best fits were defined as the distribution family and parameterization minimizing the sum of absolute error, evaluated through a simulated annealing algorithm. Gamma and Poisson distributions provided best fits for incidence, both among individual states and nationwide. Comparisons of distributions using Kullback-Leibler divergence shows that incidence by state and by municipality do not follow distributions that provide equivalent information. Few states with Gamma distributed incidence follow a distribution closely resembling that for national incidence. These results demonstrate empirically how choice of spatial resolution and scale can impact mathematical and statistical models.
Collapse
Affiliation(s)
- Joseph L. Servadio
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota, United States of America
| | - Gustavo Machado
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Julio Alvarez
- VISAVET Health Surveillance Center, Universidad Complutense, Madrid, Spain
- Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense, Madrid, Spain
| | | | - Renato Vieira Alves
- Secretaria de Vigilância em Saúde, Ministério da Saúde (SVS-MH), Brasília, Brazil
| | - Matteo Convertino
- Nexus Group, Graduate School of Information Science and Technology and GI-CoRE Station for Big-Data and Cybersecurity, Hokkaido University, Sapporo, Hokkaido, Japan
| |
Collapse
|
14
|
Ferreira da Silva PE, Junior GDSF, Ambrozio RB, Salles Tiburcio Costa MG, Machado GB, Guimarães de Carvalho SF, José de Oliveira E, Jorge DC, de Almeida Silva Teixeira L. LeishCare ®: A Software Designed for the Management of Individuals with Leishmaniases. Am J Trop Med Hyg 2020; 103:909-916. [PMID: 32602430 DOI: 10.4269/ajtmh.19-0178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The aims of this study were to describe a smartphone app aimed at healthcare professionals who work in areas endemic for visceral and tegumentary leishmaniases, and to report the user's perception of the app in these areas. The software, called LeishCare®, has the following features: data registration, image filter to record the evolution of skin lesions using photos, calculation of a score set to identify the risk of death from visceral leishmaniasis, and guides to the diseases. LeishCare® was made available to healthcare professionals in endemic municipalities in Brazil, and the perception of potential users was evaluated at baseline and after 6 and 12 months. In the first meeting, 96 (94.1%) of the 102 professionals who knew the app reported positive expectations for its use. The installation of LeishCare® on the individual device and the evaluation of user perception were completed at 6 months with 16 users and at 12 months with 20 users. More than 90% of the professionals evaluated in both assessments found the information of the app useful. The features related to the calculation of visceral leishmaniasis severity score, and the guides to leishmaniases were the most frequently accessed. Users reported competence gain attributed to the app for all items evaluated. In conclusion, LeishCare® was found to be a promising tool to help healthcare professionals in endemic areas with leishmaniasis management.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - David Calhau Jorge
- Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | | |
Collapse
|
15
|
Teixeira AIP, Silva DM, de Freitas LRS, Romero GAS. A cross-sectional approach including dog owner characteristics as predictors of visceral leishmaniasis infection in dogs. Mem Inst Oswaldo Cruz 2020; 115:e190349. [PMID: 32348406 PMCID: PMC7184770 DOI: 10.1590/0074-02760190349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 02/11/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Visceral leishmaniasis (VL) is relevant for human and animal public health. Several factors have been associated with the risk of Leishmania infantum infection in dogs. However, dog owner characteristics have been rarely explored. OBJECTIVES To estimate the prevalence and to identify the associated factors for VL infection including dog owners characteristics. METHODS A cross-sectional study was conducted including dogs from an endemic canine visceral leishmaniasis (CVL) region in the Federal District, Brazil. The infection was detected using parasitological, serological, and molecular methods. The associated factors were identified through Poisson regression modelling. FINDINGS The prevalence of infection was 26.25% [95% confidence interval (CI): 20.05 to 33.57]. The associated factors were: short coat prevalence ratio (PR) = 2.33 (95% CI: 1.02 to 5.22); presence of backyard with predominance of soil and/or vegetation PR = 4.15 (95% CI: 1.35 to 12.77); and highest gross family income score PR = 2.03 (95% CI: 1.16 to 3.54). MAIN CONCLUSION This is the first study that relates higher socioeconomic status of dog owners as an independent factor associated with higher prevalence of VL infection, along with other strongly associated factors related to receptive environment for phlebotomines. Our findings strengthen the need for exploration of the biological and behavioural bases linking dog owner characteristics to the risk of canine infection in prospective cohort studies.
Collapse
Affiliation(s)
| | - Debora Marcolino Silva
- Universidade de Brasília, Faculdade de Medicina, Núcleo de Medicina Tropical, Brasília, DF, Brasil
| | | | | |
Collapse
|
16
|
Abdelhameed A, Liao X, McElroy CA, Joice AC, Rakotondraibe L, Li J, Slebodnick C, Guo P, Wilson WD, Werbovetz KA. Synthesis and antileishmanial evaluation of thiazole orange analogs. Bioorg Med Chem Lett 2020; 30:126725. [DOI: 10.1016/j.bmcl.2019.126725] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 09/26/2019] [Accepted: 09/28/2019] [Indexed: 01/10/2023]
|
17
|
Maia-Elkhoury ANS, Sierra Romero GA, O. B. Valadas SY, L. Sousa-Gomes M, Lauletta Lindoso JA, Cupolillo E, Ruiz-Postigo JA, Argaw D, Sanchez-Vazquez MJ. Premature deaths by visceral leishmaniasis in Brazil investigated through a cohort study: A challenging opportunity? PLoS Negl Trop Dis 2019; 13:e0007841. [PMID: 31856199 PMCID: PMC6922316 DOI: 10.1371/journal.pntd.0007841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/11/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Visceral Leishmaniasis (VL) is the most severe form of leishmaniasis because it can lead to death. In the Americas, 96% of cases are in Brazil, and despite efforts, the fatality rate has increased in the past years. We analyzed deaths associated to VL in Brazil and investigated the factors that could influence on the timeliness of fatal outcome with emphasis on time (tStoD). METHODOLOGY The registered deaths by VL were sourced from the Brazilian National Notification System from 2007-2014. Through a retrospective cohort study, univariate and multivariable Cox proportional hazards model analysis were performed and investigated the factors that could influence the time (tStoD). These factors were analyzed through survival models. RESULTS Out of the 1,589 reported deaths, the median for onset of the symptoms and the case notification date (tStoN) is 25 days (10-61), and for date of case notification and death (tNotD) is 9 days (4-17). The time (tStoN) to event investigation for HIV non-infected individuals was 1.4 (1.16-1.68) greater than the HIV positive group. At the same time peri-urban and urban area were 0.83 (0.47-1.44) and 1.33 (1.16-1.52), respectively. The explorations revealed apparent differences between the time to event investigation (both for tStoN and tNotD) and the age at the onset of the symptoms. According to the tStoN the rate of notification is 1.73 times greater in patients under 5 years old at the onset of the clinical symptoms compared to older patients. CONCLUSION VL patients under 5 years old were diagnosed earlier and had shorter survival. It could mean that in younger population, although properly diagnosed, the fatality pattern might be related to the severity of the disease. Main host characteristics were evaluated, and age and co-infections seem to have an impact in the disease progression.
Collapse
Affiliation(s)
- Ana Nilce S. Maia-Elkhoury
- Communicable Diseases and Environmental Determinants of Health (CDE), Neglected, Tropical and Vector Borne Diseases (VT), Pan American Health Organization/ World Health Organization (PAHO/WHO), Duque de Caxias, Rio de Janeiro, Brazil
| | - Gustavo Adolfo Sierra Romero
- Center for Tropical Medicine, Faculty of Medicine, University of Brasilia (UNB) Brasília, Distrito Federal, Brazil
| | - Samantha Y. O. B. Valadas
- Communicable Diseases and Environmental Determinants of Health (CDE), Neglected, Tropical and Vector Borne Diseases (VT), Pan American Health Organization/ World Health Organization (PAHO/WHO), Duque de Caxias, Rio de Janeiro, Brazil
| | - Marcia L. Sousa-Gomes
- Secretary of Health Surveillance (SVS), Ministry of Health, Brasilia, Distrito Federal, Brazil
| | - José Angelo Lauletta Lindoso
- Institute of Infectology Emilio Ribas and Institute of Tropical Medicine from University of São Paulo, São Paulo, Brazil
| | - Elisa Cupolillo
- Oswaldo Cruz Institute (IOC) Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Jose Antonio Ruiz-Postigo
- Department of Neglected Tropical Diseases (HTM/NTD/IDM), World Health Organization (WHO), Geneva, Switzerland
| | - Daniel Argaw
- Department of Neglected Tropical Diseases (HTM/NTD/IDM), World Health Organization (WHO), Geneva, Switzerland
| | | |
Collapse
|
18
|
de Carvalho IPSF, Peixoto HM, Romero GAS, de Oliveira MRF. Treatment for human visceral leishmaniasis: a cost-effectiveness analysis for Brazil. Trop Med Int Health 2019; 24:1064-1077. [PMID: 31278808 DOI: 10.1111/tmi.13284] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To estimate the cost-effectiveness of strategies for the treatment of VL in Brazil. METHODS Cost-effectiveness study comparing three therapeutic options: meglumine antimoniate (MA), liposomal amphotericin B (LAMB) and a combination of LAMB plus MA (LAMB plus MA), from public health system and societal perspectives. An analytical decision-making model was used to compare strategies for the following outcomes: early therapeutic failure avoided at 30 days, days of hospitalisation avoided and VL cure at 180 days. The efficacy and safety parameters of the drugs came from a randomised, open-label trial and the cost data came from a cost-of-illness study, both carried out in Brazil. RESULTS For all outcomes analysed, the LAMB strategy was more effective. The MA strategy was inferior to the LAMB plus MA strategy for the outcomes early therapeutic failure avoided and cure. When only LAMB and MA were compared from a societal perspective, a cost of US$ 278.56 was estimated for each additional early therapeutic failure avoided, a cost of US$ 26.88 for each additional day of hospitalisation avoided and a cost of US$ 89.88 for each additional case of cured VL, for the LAMB strategy vs. MA. CONCLUSION In Brazil, the LAMB strategy proved to be cost-effective for treating VL, considering a GDP per capita as the willingness-to-pay threshold, for all of the outcomes analysed in comparison to MA.
Collapse
Affiliation(s)
| | - Henry Maia Peixoto
- Centre for Tropical Medicine, University of Brasilia, Brasilia, Brazil.,National Institute for Science and Technology for Health Technology Assessment, Porto Alegre, Brazil
| | - Gustavo Adolfo Sierra Romero
- Centre for Tropical Medicine, University of Brasilia, Brasilia, Brazil.,National Institute for Science and Technology for Health Technology Assessment, Porto Alegre, Brazil
| | - Maria Regina Fernandes de Oliveira
- Centre for Tropical Medicine, University of Brasilia, Brasilia, Brazil.,National Institute for Science and Technology for Health Technology Assessment, Porto Alegre, Brazil
| |
Collapse
|
19
|
Scariot DB, Volpato H, Fernandes NDS, Soares EFP, Ueda-Nakamura T, Dias-Filho BP, Din ZU, Rodrigues-Filho E, Rubira AF, Borges O, Sousa MDC, Nakamura CV. Activity and Cell-Death Pathway in Leishmania infantum Induced by Sugiol: Vectorization Using Yeast Cell Wall Particles Obtained From Saccharomyces cerevisiae. Front Cell Infect Microbiol 2019; 9:208. [PMID: 31259161 PMCID: PMC6587907 DOI: 10.3389/fcimb.2019.00208] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/28/2019] [Indexed: 12/22/2022] Open
Abstract
Visceral leishmaniasis, caused by Leishmania infantum, is a neglected tropical disease, to which efforts in the innovation of effective and affordable treatments remain limited, despite the rising incidence in several regions of the world. In this work, the antileishmanial effects of sugiol were investigated in vitro. This compound was isolated from the bark of Cupressus lusitanica and showed promising activity against L. infantum. In spite of the positive results, it is known that the compound is a poorly water-soluble diterpene molecule, which hinders further investigation, especially in preclinical animal studies. Thus, in an alternative delivery method, sugiol was entrapped in glucan-rich particles obtained from Saccharomyces cerevisiae yeast cell walls (YCWPs). To evaluate the activity of sugiol, the experiments were divided into two parts: (i) the in vitro investigation of antileishmanial activity of free sugiol against L. infantum promastigotes after 24, 48, and 72 h of treatment and (ii) the evaluation of antileishmanial activity of sugiol entrapped in glucan-rich particles against intracellular L. infantum amastigotes. Free sugiol induced the cell-death process in promastigotes, which was triggered by enhancing cytosolic calcium level and promoting the autophagy up to the first 24 h. Over time, the presence of autophagic vacuoles became rarer, especially after treatment with lower concentrations of sugiol, but other cellular events intensified, like ROS production, cell shrinkage, and phosphatidylserine exposure. Hyperpolarization of mitochondrial membrane potential was found at 72 h, induced by the mitochondria calcium uptake, causing an increase in ROS production and lipid peroxidation as a consequence. These events resulted in the cell death of promastigotes by secondary necrosis. Sugiol entrapped in glucan-rich particles was specifically recognized by dectin-1 receptor on the plasma membrane of macrophages, the main host cell of Leishmania spp. Electron micrographs revealed particles containing sugiol within the infected macrophages and these particles were active against the intracellular L. infantum amastigotes without affecting the host cell. Therefore, the YCWPs act like a Trojan horse to successfully deliver sugiol into the macrophage, presenting an interesting strategy to deliver water-insoluble drugs to parasitized cells.
Collapse
Affiliation(s)
- Débora Botura Scariot
- Laboratory of Technological Innovation in Drugs and Cosmetics Development, State University of Maringá, Maringá, Brazil
| | - Hélito Volpato
- Laboratory of Technological Innovation in Drugs and Cosmetics Development, State University of Maringá, Maringá, Brazil
| | - Nilma de Souza Fernandes
- Laboratory of Technological Innovation in Drugs and Cosmetics Development, State University of Maringá, Maringá, Brazil
| | | | - Tânia Ueda-Nakamura
- Laboratory of Technological Innovation in Drugs and Cosmetics Development, State University of Maringá, Maringá, Brazil
| | - Benedito Prado Dias-Filho
- Laboratory of Technological Innovation in Drugs and Cosmetics Development, State University of Maringá, Maringá, Brazil
| | - Zia Ud Din
- Chemistry Department, Federal University of São Carlos, São Carlos, Brazil
| | | | | | - Olga Borges
- Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.,CNC - Center for Neurosciences and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Maria Do Céu Sousa
- Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.,CNC - Center for Neurosciences and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Celso Vataru Nakamura
- Laboratory of Technological Innovation in Drugs and Cosmetics Development, State University of Maringá, Maringá, Brazil
| |
Collapse
|
20
|
Assis TSMD, Rabello A, Cota G, Werneck GL, Azeredo-da-Silva ALFD. Cost-effectiveness analysis of diagnostic-therapeutic strategies for visceral leishmaniasis in Brazil. Rev Soc Bras Med Trop 2019; 52:e20180272. [PMID: 30994802 DOI: 10.1590/0037-8682-0272-2018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 08/30/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Visceral leishmaniasis (VL) is fatal if not diagnosed and treated. This study aimed to estimate the cost-effectiveness of diagnostic-therapeutic alternatives for VL in Brazil. METHODS A decision model estimated the life expectancy and costs of six diagnostic-therapeutic strategies. RESULTS IT LEISH + liposomal amphotericin B emerged the best option, presenting lower costs and higher effectiveness. DAT-LPC + liposomal amphotericin B showed an incremental cost-effectiveness ratio of US$ 326.31 per life year. CONCLUSIONS These findings indicate the feasibility of incorporating DAT and designating liposomal amphotericin B as the first-line drug for VL in Brazil.
Collapse
Affiliation(s)
- Tália Santana Machado de Assis
- Centro Federal de Educação Tecnológica de Minas Gerais, Contagem, MG, Brasil.,Grupo de Pesquisa: Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, MG, Brasil
| | - Ana Rabello
- Grupo de Pesquisa: Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, MG, Brasil
| | - Gláucia Cota
- Grupo de Pesquisa: Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias, Belo Horizonte, MG, Brasil
| | - Guilherme Loureiro Werneck
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, RJ, Brasil
| | | |
Collapse
|
21
|
Nascimento GL, Pegado HM, Domingues ALC, Ximenes RADA, Itria A, Cruz LN, Oliveira MRFD. The cost of a disease targeted for elimination in Brazil: the case of schistosomiasis mansoni. Mem Inst Oswaldo Cruz 2019; 114:e180347. [PMID: 30652735 PMCID: PMC6340134 DOI: 10.1590/0074-02760180347] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/10/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Schistosomiasis mansoni is a poverty-related parasitic infection that has a
variety of clinical manifestations. We consider the disability and deaths
caused by schistosomiasis unacceptable for a tool-ready disease. Its
condition in Brazil warrants an analysis that will enable better
understanding of the local health losses and contribute to the complex
decision-making process. OBJECTIVE This study estimates the cost of schistosomiasis in Brazil in 2015. METHODS We conducted a cost of illness study of schistosomiasis mansoni in Brazil in
2015 based on a prevalence approach and from a societal perspective. The
study included 26,499 schistosomiasis carriers, 397 hepatosplenic cases, 48
cases with the neurological form, 284 hospitalisations, and 11,368.26 years
of life lost (YLL) of which 5,187 years are attributable to economically
active age groups. RESULTS The total cost of schistosomiasis mansoni in Brazil was estimated to be US$
41,7million in 2015 with 94.61% of this being indirect costs. CONCLUSIONS The economic burden of schistosomiasis mansoni in Brazil is high and results
in the loss of productivity. Its persistence in Brazil is a challenge to
public health and requires inter-sectorial interventions in areas such as
indoor water supply, basic sanitation, and education.
Collapse
Affiliation(s)
| | | | | | | | - Alexander Itria
- Universidade Federal de Goiás, Goiânia, GO, Brasil.,Instituto de Avaliação de Tecnologias em Saúde, Porto Alegre, RS, Brasil
| | | | - Maria Regina Fernandes de Oliveira
- Universidade de Brasília, Núcleo de Medicina Tropical, Brasília, DF, Brasil.,Instituto de Avaliação de Tecnologias em Saúde, Porto Alegre, RS, Brasil
| |
Collapse
|
22
|
Sunyoto T, Boelaert M, Meheus F. Understanding the economic impact of leishmaniasis on households in endemic countries: a systematic review. Expert Rev Anti Infect Ther 2019; 17:57-69. [PMID: 30513027 DOI: 10.1080/14787210.2019.1555471] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 11/30/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Leishmaniasis is a poverty-related disease that causes a significant socioeconomic burden to affected households. Visceral leishmaniasis is fatal if untreated, yet illness costs may lead to delays in accessing care. Skin manifestations of leishmaniasis cause a psychological burden and even longer treatment trajectories. The objective of this review is to evaluate illness costs associated with leishmaniasis across different settings (Asia, Africa, and Latin America) and the consequences to households. Areas covered: Through a systematic review of cost-of-illness studies, we documented the distribution of costs, the health-seeking behavior, and the consequences of leishmaniasis. We discuss the value of cost-of-illness studies for leishmaniasis. Expert commentary: Despite the free provision of diagnostics and treatment in the public health care sector, out-of-pocket payments remain substantial. There has been progress in addressing the economic burden of leishmaniasis, particularly through the elimination initiative in the Indian subcontinent. Though the illness cost is decreasing due to shorter treatment regimens and better access to care, the situation remains challenging in Africa. Improvement of control tools is critical. There is a need to update cost estimates to inform policy-making and ensure sustainable solutions to reduce financial barriers to leishmaniasis care, especially in pursuing universal health coverage.
Collapse
Affiliation(s)
- Temmy Sunyoto
- a Public Health Department , Institute of Tropical Medicine , Antwerpen , Belgium
| | - Marleen Boelaert
- a Public Health Department , Institute of Tropical Medicine , Antwerpen , Belgium
| | - Filip Meheus
- b Early Detection and Prevention Section , International Agency for Research on Cancer , Lyon , France
| |
Collapse
|
23
|
Dias JCA, Monteiro LHA. Clustered Breeding Sites: Shelters for Vector-Borne Diseases. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2018; 2018:2575017. [PMID: 30112017 PMCID: PMC6077366 DOI: 10.1155/2018/2575017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 06/03/2018] [Indexed: 11/17/2022]
Abstract
Here, the propagation of vector-borne diseases is modeled by using a probabilistic cellular automaton. Numerical simulations considering distinct spatial distributions and time variations of the vector abundance are performed, in order to investigate their impacts on the number of infected individuals of the host population. The main conclusion is as follows: in the clustered distributions, the prevalence is lower, but the eradication is more difficult to be achieved, as compared to homogeneous distributions. This result can be relevant in the implementation of preventive surveillance measures.
Collapse
Affiliation(s)
- J. C. A. Dias
- Universidade Presbiteriana Mackenzie, PPGEEC, São Paulo, SP, Brazil
| | - L. H. A. Monteiro
- Universidade Presbiteriana Mackenzie, PPGEEC, São Paulo, SP, Brazil
- Universidade de São Paulo, Escola Politécnica, São Paulo, SP, Brazil
| |
Collapse
|