Economic Evaluation of Using Pesticides to Control Cutaneous Leishmaniasis in Isfahan

OBJECTIVE: Pesticides have been used as the main part of the national cutaneous leishmaniasis control program for serveral years in Iran. However, the cost-effectiveness of this strategy has not been yet analyzed. The aim of this study is to to analyze the cost-effectiveness and cost-utility of using pesticides as the main strategy to prevent rural CL in Isfahan. METHODS: This is an economic evaluation study performed from a health system perspective to estimate the cost-effectiveness and cost-utility of the control strategy with and without pesticides. The outcome measures are incidence rate of cutaneous leishmaniasis and the disability-adjusted life years (DALYs). The cost-effectiveness and cost-utility have been analyzed by calculating incremental cost-effectiveness ratio (ICER). Data of cost and incidence rate obtained from the health centers of Isfahan University of Medical Sciences and Vice-Chancellery for Health. The disability weight was obtained from the literature. A one-way sensitivity analysis was applied with a 20% increase and decrease in costs. FINDINGS: The total cost of control program in 2013 and 2014 were US$578,453 (ppp) and US$14,978.2 (ppp), respectively. The incidence rate of cutaneous leishmaniasis was estimated at 1396 and 1277 (per 100,000 population in hyperendemic areas where pesticides have been used) in 2013 and 2014, respectively. DALY lost due to disease was estimated to be 8.024 and 7.342 in 2013 and 2014, correspondingly. Both the cost-effectiveness and the cost-utility analyses resulted in negative ICERs, lying in the rejection area of the ICER plane. CONCLUSION: The use of pesticides to prevent cutaneous leishmaniasis (rural sicker) in Isfahan province has not proved to offer a reduction in the incidence rate of cutaneous leishmaniasis as well as reduction in DALYs lost. However, due to data availability limitation, the time frame for this study was limited. A prospective design with longitudinal data is recommended to be used by future research. Other alternatives to raise population awareness about different aspects of disease should be also considered for evaluation.