Cost-effectiveness of serological tests for human visceral leishmaniasis in the Brazilian scenario

Detalhes bibliográficos
Autor(a) principal: Freire, Mariana Lourenco
Data de Publicação: 2020
Outros Autores: Souza, Aline de, Cota, Gláucia Fernandes, Rabello, Ana Lúcia Teles, Assis, Tália Machado de
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Institucional da FIOCRUZ (ARCA)
DOI: 10.1371/journal.pntd.0008741
Texto Completo: https://www.arca.fiocruz.br/handle/icict/58582
Resumo: Fundação Oswaldo Cruz. Instituto René Rachou. Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias. Belo Horizonte, MG, Brasil.
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spelling Freire, Mariana LourencoSouza, Aline deCota, Gláucia FernandesRabello, Ana Lúcia TelesAssis, Tália Machado de2023-05-23T15:29:23Z2023-05-23T15:29:23Z2020FREIRE, Mariana Lourenço et al. Cost-effectiveness of serological tests for human visceral leishmaniasis in the Brazilian scenario. PLoS Negl Trop Dis., v. 14, n. 10, e0008741, 2020. doi: 10.1371/journal.pntd.0008741.1935-2735https://www.arca.fiocruz.br/handle/icict/5858210.1371/journal.pntd.0008741engPublic Library of ScienceCost-effectiveness of serological tests for human visceral leishmaniasis in the Brazilian scenarioinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleFundação Oswaldo Cruz. Instituto René Rachou. Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Instituto René Rachou. Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Instituto René Rachou. Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Instituto René Rachou. Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias. Belo Horizonte, MG, Brasil.Fundação Oswaldo Cruz. Instituto René Rachou. Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias. Belo Horizonte, MG, Brasil/ Centro Federal de Educação Tecnológica de Minas Gerais. Contagem, MG, Brasil.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. Author summary Human visceral leishmaniasis (VL) is a neglected illness affecting economically vulnerable populations in more than 80 countries. Approximately 90% of the cases registered in Latin American occur in Brazil, where more than 7% of cases are also HIV-infected, and the public health system sustains the costs of illness. Considering the importance of correct diagnosis for VL control and for the optimal use of limited public health resources, we present a cost-effectiveness analysis of the available tests in Brazil up to 2019, stratified according to HIV status. In the different analyses performed, a national noncommercial direct agglutination test (DAT-LPC) and the rapid test IT LEISH were the most cost-effective diagnostic tests. DAT-LPC is especially cost-effective for VL screening among HIV-infected patients, presenting the lowest cost and highest effectiveness. DAT-LPC and IT LEISH are tests that can be performed in laboratories with minimal installed infrastructure, allowing cost-effective strategies for the diagnostic investigation of cases with VL symptoms. The results confirm the importance of cost-effectiveness analyses prior to the incorporation of new health technologies.info:eu-repo/semantics/openAccessreponame:Repositório Institucional da FIOCRUZ (ARCA)instname:Fundação Oswaldo Cruz (FIOCRUZ)instacron:FIOCRUZORIGINALCost-effectiveness of serological tests for human.pdfCost-effectiveness of serological tests for human.pdfapplication/pdf521973https://www.arca.fiocruz.br/bitstream/icict/58582/2/Cost-effectiveness%20of%20serological%20tests%20for%20human.pdfbe466f4c52a81fe4965e89fadc4c3a99MD52LICENSElicense.txttext/plain1748https://www.arca.fiocruz.br/bitstream/icict/58582/1/license.txt8a4605be74aa9ea9d79846c1fba20a33MD51icict/585822023-05-23 12:29:24.344oai:www.arca.fiocruz.br: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Repositório InstitucionalPUBhttps://www.arca.fiocruz.br/oai/requestrepositorio.arca@fiocruz.bropendoar:21352023-05-23T15:29:24Repositório Institucional da FIOCRUZ (ARCA) - Fundação Oswaldo Cruz (FIOCRUZ)false
dc.title.en_US.fl_str_mv Cost-effectiveness of serological tests for human visceral leishmaniasis in the Brazilian scenario
title Cost-effectiveness of serological tests for human visceral leishmaniasis in the Brazilian scenario
spellingShingle Cost-effectiveness of serological tests for human visceral leishmaniasis in the Brazilian scenario
Freire, Mariana Lourenco
title_short Cost-effectiveness of serological tests for human visceral leishmaniasis in the Brazilian scenario
title_full Cost-effectiveness of serological tests for human visceral leishmaniasis in the Brazilian scenario
title_fullStr Cost-effectiveness of serological tests for human visceral leishmaniasis in the Brazilian scenario
title_full_unstemmed Cost-effectiveness of serological tests for human visceral leishmaniasis in the Brazilian scenario
title_sort Cost-effectiveness of serological tests for human visceral leishmaniasis in the Brazilian scenario
author Freire, Mariana Lourenco
author_facet Freire, Mariana Lourenco
Souza, Aline de
Cota, Gláucia Fernandes
Rabello, Ana Lúcia Teles
Assis, Tália Machado de
author_role author
author2 Souza, Aline de
Cota, Gláucia Fernandes
Rabello, Ana Lúcia Teles
Assis, Tália Machado de
author2_role author
author
author
author
dc.contributor.author.fl_str_mv Freire, Mariana Lourenco
Souza, Aline de
Cota, Gláucia Fernandes
Rabello, Ana Lúcia Teles
Assis, Tália Machado de
description Fundação Oswaldo Cruz. Instituto René Rachou. Pesquisa Clínica e Políticas Públicas em Doenças Infecciosas e Parasitárias. Belo Horizonte, MG, Brasil.
publishDate 2020
dc.date.issued.fl_str_mv 2020
dc.date.accessioned.fl_str_mv 2023-05-23T15:29:23Z
dc.date.available.fl_str_mv 2023-05-23T15:29:23Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.citation.fl_str_mv FREIRE, Mariana Lourenço et al. Cost-effectiveness of serological tests for human visceral leishmaniasis in the Brazilian scenario. PLoS Negl Trop Dis., v. 14, n. 10, e0008741, 2020. doi: 10.1371/journal.pntd.0008741.
dc.identifier.uri.fl_str_mv https://www.arca.fiocruz.br/handle/icict/58582
dc.identifier.issn.en_US.fl_str_mv 1935-2735
dc.identifier.doi.none.fl_str_mv 10.1371/journal.pntd.0008741
identifier_str_mv FREIRE, Mariana Lourenço et al. Cost-effectiveness of serological tests for human visceral leishmaniasis in the Brazilian scenario. PLoS Negl Trop Dis., v. 14, n. 10, e0008741, 2020. doi: 10.1371/journal.pntd.0008741.
1935-2735
10.1371/journal.pntd.0008741
url https://www.arca.fiocruz.br/handle/icict/58582
dc.language.iso.fl_str_mv eng
language eng
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dc.publisher.none.fl_str_mv Public Library of Science
publisher.none.fl_str_mv Public Library of Science
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