RESUMEN
Human African trypanosomiasis (HAT) is a disease caused by infection with the parasite Trypanosoma brucei gambiense or T. b. rhodesiense. It is transmitted to humans via the tsetse fly. Approximately 70 million people worldwide were at risk of infection in 1995, and approximately 20,000 people across Africa are infected with HAT. The objective of this review was to identify existing economic evaluations in order to summarise cost-effective interventions to reduce, control, or eliminate the burden of HAT. The studies included in the review were compared and critically appraised in order to determine if there were existing standardised methods that could be used for economic evaluation of HAT interventions or if innovative methodological approaches are warranted. A search strategy was developed using keywords and was implemented in January 2014 in several databases. The search returned a total of 2,283 articles. After two levels of screening, a total of seven economic evaluations were included and underwent critical appraisal using the Scottish Intercollegiate Guidelines Network (SIGN) Methodology Checklist 6: Economic Evaluations. Results from the existing studies focused on the cost-effectiveness of interventions for the control and reduction of disease transmission. Modelling was a common method to forecast long-term results, and publications focused on interventions by category, such as case detection, diagnostics, drug treatments, and vector control. Most interventions were considered cost-effective based on the thresholds described; however, the current treatment, nifurtomix-eflornithine combination therapy (NECT), has not been evaluated for cost-effectiveness, and considerations for cost-effective strategies for elimination have yet to be completed. Overall, the current evidence highlights the main components that play a role in control; however, economic evaluations of HAT elimination strategies are needed to assist national decision makers, stakeholders, and key funders. These analyses would be of use, as HAT is currently being prioritized as a neglected tropical disease (NTD) to reach elimination by 2020.
Asunto(s)
Análisis Costo-Beneficio , Enfermedades Desatendidas/prevención & control , Tripanocidas/uso terapéutico , Tripanosomiasis Africana/economía , Tripanosomiasis Africana/terapia , África , Animales , Eflornitina/economía , Eflornitina/uso terapéutico , Humanos , Insectos Vectores/parasitología , Modelos Teóricos , Enfermedades Desatendidas/economía , Medicina Tropical/economía , Tripanocidas/economía , Trypanosoma brucei gambiense/patogenicidad , Tripanosomiasis Africana/parasitología , Moscas Tse-Tse/parasitologíaRESUMEN
Despite the fact that eflornithine was considered as the safer drug to treat human African trypanosomiasis (HAT) and has been freely available since 2001, the difficulties in logistics and cost burden associated with this drug meant that the toxic melarsoprol remained the drug of choice. The World Health Organization responded to the situation by designing a medical kit containing all the materials needed to use eflornithine, and by implementing a training and drugs distribution programme which has allowed a transition to this much safer treatment. The introduction of the combination of nifurtimox and eflornithine (NECT) has accelerated the shift from melarsoprol to the best treatment available, due to reduced dosage and treatment time for eflornithine that has significantly lessened the cost and improved the burden of logistics encountered during treatment and distribution. The decrease in the use of more dangerous but cheaper melarsoprol has meant a rise in the per patient cost of treating HAT. Although NECT is cheaper than eflornithine monotherapy, an unexpected consequence has been a continuing rise in the per patient cost of treating HAT. The ethical decision of shifting to the best available treatment imposes a financial burden on HAT control programmes that might render long-term application unsustainable. These factors call for continuing research to provide new safer and more effective drugs that are simple to administer and cheaper when compared to current drugs.
Asunto(s)
Tripanocidas/economía , Tripanocidas/uso terapéutico , Tripanosomiasis Africana/tratamiento farmacológico , Animales , Quimioterapia Combinada , Eflornitina/economía , Eflornitina/uso terapéutico , Accesibilidad a los Servicios de Salud , Humanos , Melarsoprol/economía , Melarsoprol/uso terapéutico , Nifurtimox/economía , Nifurtimox/uso terapéutico , Tripanosomiasis Africana/parasitologíaRESUMEN
OBJECTIVE: To compare the cost-effectiveness of eflornithine and melarsoprol in the treatment of human African trypanosomiasis. METHOD: We used data from a Médecins Sans Frontières treatment project in Caxito, Angola to do a formal cost-effectiveness analysis, comparing the efficiency of an eflornithine-based approach with melarsoprol. Endpoints calculated were: cost per death avoided; incremental cost per additional life saved; cost per years of life lost (YLL) averted; incremental cost per YLL averted. Sensitivity analysis was done for all parameters for which uncertainty existed over the plausible range. We did an analysis with and without cost of trypanocidal drugs included. RESULTS: Effectiveness was 95.6% for melarsoprol and 98.7% for eflornithine. Cost/patient was 504.6 for melarsoprol and 552.3 for eflornithine, cost per life saved was 527.5 USD for melarsoprol and 559.8 USD for eflornithine without cost of trypanocidal drugs but it increases to 600.4 USD and 844.6 USD per patient saved and 627.6 USD and 856.1 USD per life saved when cost of trypanocidal drugs are included. Incremental cost-effectiveness ratio is 1596 USD per additional life saved and 58 USD per additional life year saved in the baseline scenario without cost of trypanocidal drugs but it increases to 8169 USD per additional life saved and 299 USD per additional life year saved if costs of trypanocidal drugs are included. CONCLUSION: Eflornithine saves more lives than melarsoprol, but melarsoprol is slightly more cost-effective. Switching from melarsoprol to eflornithine can be considered as a cost-effective option according to the WHO choice criteria.
Asunto(s)
Costo de Enfermedad , Eflornitina/economía , Melarsoprol/economía , Tripanocidas/economía , Tripanosomiasis Africana/tratamiento farmacológico , Tripanosomiasis Africana/economía , Angola , Animales , Análisis Costo-Beneficio , Eflornitina/uso terapéutico , Humanos , Melarsoprol/uso terapéutico , Resultado del Tratamiento , Tripanocidas/uso terapéutico , Tripanosomiasis Africana/mortalidad , Tripanosomiasis Africana/parasitologíaRESUMEN
Many women develop male-pattern facial hair (facial hirsutism), which can be distressing and difficult to treat. Eflornithine (Vaniqa - Shire) is a topical cream available only on prescription for treating women with facial hirsutism. Promotional material claims that the treatment "slows facial hair growth - grows her confidence". Does this product have a place in the management of women with hirsutism?
Asunto(s)
Eflornitina/uso terapéutico , Inhibidores Enzimáticos/uso terapéutico , Hirsutismo/tratamiento farmacológico , Adulto , Costos de los Medicamentos , Eflornitina/economía , Inhibidores Enzimáticos/economía , Femenino , Hirsutismo/economía , Humanos , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como AsuntoAsunto(s)
Industria Farmacéutica/tendencias , Eflornitina/economía , Eflornitina/uso terapéutico , África/epidemiología , Antineoplásicos/efectos adversos , Antineoplásicos/uso terapéutico , Países en Desarrollo , Industria Farmacéutica/economía , Humanos , Estilo de Vida , Tripanocidas/uso terapéutico , Tripanosomiasis Africana/tratamiento farmacológico , Tripanosomiasis Africana/epidemiología , Organización Mundial de la SaludRESUMEN
Human African Trypanosomiasis (HAT) is a re-emerging disease whose usual treatments are becoming less efficient because of the increasing parasite resistance. Availability of HAT drugs is poor and their production in danger because of technical, ecological and economic constraints. In view of this dramatic situation, a network involving experts from NGOs, WHO and pharmaceutical producers was commissioned with updating estimates of need for each HAT drug for the coming years; negotiations with potential producers of new drugs such as eflornithine; securing sustainable manufacturing of existing drugs; clinical research into new combinations of these drugs for first and second-line treatments; centralizing drug purchases and their distribution through a unique non-profit entity; and addressing regulatory and legal issues concerning new drugs.
Asunto(s)
Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/tendencias , Tripanocidas/economía , Tripanocidas/provisión & distribución , Tripanosomiasis Africana/tratamiento farmacológico , Eflornitina/economía , Eflornitina/provisión & distribución , Eflornitina/uso terapéutico , Humanos , Melarsoprol/economía , Melarsoprol/provisión & distribución , Melarsoprol/uso terapéutico , Pentamidina/economía , Pentamidina/provisión & distribución , Pentamidina/uso terapéutico , Investigación/economía , Suramina/economía , Suramina/provisión & distribución , Suramina/uso terapéutico , Tripanocidas/uso terapéutico , Tripanosomiasis Africana/economía , Organización Mundial de la SaludAsunto(s)
Países en Desarrollo , Costos de los Medicamentos/estadística & datos numéricos , Industria Farmacéutica/economía , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , África Oriental , Fármacos Anti-VIH/economía , Eflornitina/economía , Remoción del Cabello , Humanos , Sistemas PolíticosRESUMEN
African trypanosomiasis, or sleeping sickness, is a tropical disease caused by trypanosome parasites transmitted by tsetse flies. The focus of this paper is on the cost-effectiveness of alternative drug treatments for patients in the late stage of the disease. Melarsoprol has been used for many decades. More recently, eflornithine has been developed. It has fewer side effects and improves the overall cure rate. It is much more expensive than melarsoprol, however. The objective of the present cost-effectiveness is to identify the costs and benefits that would be involved in switching from melarsoprol to eflornithine in the treatment of late stage sleeping sickness. Benefits are expressed in lives saved as well as in disability adjusted life years (DALYs). The analysis is applied to the case of Uganda. The implications for affordability are also considered, by taking account of how the treatment costs would be shared between the national government, donors and patients. The baseline results indicate that melarsoprol treatment is associated with an incremental cost per life and DALY saved of $209 and $8, respectively. Each additional life saved by switching from melarsoprol alone to a combination of melarsoprol and eflornithine would cost an extra $1,033 per life saved, and an extra $40.9 per DALY gained. Shifting from this second alternative to treatment of all patients with eflornithine leads to an incremental cost per life saved of $4,444 and an incremental cost of $166.8 per DALY gained.
Asunto(s)
Costo de Enfermedad , Eflornitina/economía , Asignación de Recursos para la Atención de Salud/economía , Tripanocidas/economía , Trypanosoma brucei gambiense , Tripanosomiasis Africana/tratamiento farmacológico , Animales , Análisis Costo-Beneficio , Árboles de Decisión , Progresión de la Enfermedad , Quimioterapia Combinada , Eflornitina/uso terapéutico , Ética Médica , Apoyo Financiero , Política de Salud , Humanos , Melarsoprol/efectos adversos , Melarsoprol/economía , Melarsoprol/uso terapéutico , Años de Vida Ajustados por Calidad de Vida , Recurrencia , Tripanocidas/uso terapéutico , UgandaRESUMEN
The authors review the available products used for human african trypanosomiasis (HAT) chemotherapy: pentamidine, suramin, melarsoprol and the new compound DFMO. The administration of pentamidine at the beginning of the nervous stage, when the number of cells in the cerebrospinal fluid do not exceed 20/mn3 is a new approach for HAT treatment. At this time of the disease, patients generally are healthy and the pentamidine therapy avoids the use of the toxic melarsoprol (Arsobal). An alternative protocol for Arsobal therapy (2, 16 mg/kg/d for 10 consecutive days) has been described from pharmacokinetics data to decrease the rate of relapses and the duration of hospital care. Efficacy and tolerance of this new protocol must be evaluated by randomised clinical trials. Preliminary data of clinical trials using short-term DFMO therapy are encouraging. DFMO therapy be less expensive. From its efficacy and tolerance, DFMO is a choice chemotherapy for HAT treatment, especially in the case of resistance to usual trypanocides. Both MLD 73811 and IMOL 881 are new trypanocidal compounds, effective on Trypanosoma brucei rhodesiense and T. b. gambiense. In addition, IMOL 881 is effective on the animal trypanosomes, T. evansi and T. equiperdum. Waiting for the availability of these new products, classical trypanocides remain the basis of HAT treatment.