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Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis

India has the highest burden of leprosy in the world. Following a recent WHO guideline, the Indian National Leprosy Programme is introducing post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) in all high-endemic districts of the country. The aim of this study is to estimate the long-ter...

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Autores principales: Tiwari, Anuj, Blok, David J., Arif, Mohammad, Richardus, Jan Hendrik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428216/
https://www.ncbi.nlm.nih.gov/pubmed/32750059
http://dx.doi.org/10.1371/journal.pntd.0008521
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author Tiwari, Anuj
Blok, David J.
Arif, Mohammad
Richardus, Jan Hendrik
author_facet Tiwari, Anuj
Blok, David J.
Arif, Mohammad
Richardus, Jan Hendrik
author_sort Tiwari, Anuj
collection PubMed
description India has the highest burden of leprosy in the world. Following a recent WHO guideline, the Indian National Leprosy Programme is introducing post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) in all high-endemic districts of the country. The aim of this study is to estimate the long-term cost-effectiveness of SDR-PEP in different leprosy disability burden situations. We used a stochastic individual-based model (SIMCOLEP) to simulate the leprosy new case detection rate trend and the impact of implementing contact screening and SDR-PEP from 2016 to 2040 (25 years) in the Union Territory of Dadra Nagar Haveli (DNH) in India. Effects of the intervention were expressed as disability adjusted life years (DALY) averted under three assumption of disability prevention: 1) all grade 1 disability (G1D) cases prevented; 2) G1D cases prevented in PB cases only; 3) no disability prevented. Costs were US$ 2.9 per contact. Costs and effects were discounted at 3%. The incremental cost per DALY averted by SDR-PEP was US$ 210, US$ 447, and US$ 5,673 in the 25(th) year under assumption 1, 2, and 3, respectively. If prevention of G1D was assumed, the probability of cost-effectiveness was 1.0 at the threshold of US$ 2,000, which is equivalent to the GDP per capita of India. The probability of cost-effectiveness was 0.6, if no disability prevention was assumed. The cost per new leprosy case averted was US$ 2,873. Contact listing, screening and the provision of SDR-PEP is a cost-effective strategy in leprosy control in both the short (5 years) and long term (25 years). The cost-effectiveness depends on the extent to which disability can be prevented. As the intervention becomes increasingly cost-effective in the long term, we recommend a long-term commitment for its implementation.
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spelling pubmed-74282162020-08-20 Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis Tiwari, Anuj Blok, David J. Arif, Mohammad Richardus, Jan Hendrik PLoS Negl Trop Dis Research Article India has the highest burden of leprosy in the world. Following a recent WHO guideline, the Indian National Leprosy Programme is introducing post-exposure prophylaxis with single-dose rifampicin (SDR-PEP) in all high-endemic districts of the country. The aim of this study is to estimate the long-term cost-effectiveness of SDR-PEP in different leprosy disability burden situations. We used a stochastic individual-based model (SIMCOLEP) to simulate the leprosy new case detection rate trend and the impact of implementing contact screening and SDR-PEP from 2016 to 2040 (25 years) in the Union Territory of Dadra Nagar Haveli (DNH) in India. Effects of the intervention were expressed as disability adjusted life years (DALY) averted under three assumption of disability prevention: 1) all grade 1 disability (G1D) cases prevented; 2) G1D cases prevented in PB cases only; 3) no disability prevented. Costs were US$ 2.9 per contact. Costs and effects were discounted at 3%. The incremental cost per DALY averted by SDR-PEP was US$ 210, US$ 447, and US$ 5,673 in the 25(th) year under assumption 1, 2, and 3, respectively. If prevention of G1D was assumed, the probability of cost-effectiveness was 1.0 at the threshold of US$ 2,000, which is equivalent to the GDP per capita of India. The probability of cost-effectiveness was 0.6, if no disability prevention was assumed. The cost per new leprosy case averted was US$ 2,873. Contact listing, screening and the provision of SDR-PEP is a cost-effective strategy in leprosy control in both the short (5 years) and long term (25 years). The cost-effectiveness depends on the extent to which disability can be prevented. As the intervention becomes increasingly cost-effective in the long term, we recommend a long-term commitment for its implementation. Public Library of Science 2020-08-04 /pmc/articles/PMC7428216/ /pubmed/32750059 http://dx.doi.org/10.1371/journal.pntd.0008521 Text en © 2020 Tiwari et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Tiwari, Anuj
Blok, David J.
Arif, Mohammad
Richardus, Jan Hendrik
Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis
title Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis
title_full Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis
title_fullStr Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis
title_full_unstemmed Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis
title_short Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis
title_sort leprosy post-exposure prophylaxis in the indian health system: a cost-effectiveness analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428216/
https://www.ncbi.nlm.nih.gov/pubmed/32750059
http://dx.doi.org/10.1371/journal.pntd.0008521
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