Abstract
BackgroundDespite several leprosy control measures in Nigeria, child proportion and disability grade 2 cases remain high while new cases have not significantly reduced, suggesting continuous spread of the disease. Hence, there is the need to review detection methods to enhance identification of early cases for effective control and prevention of permanent disability. This study evaluated the cost-effectiveness of three leprosy case detection methods in Northern Nigeria to identify the most cost-effective approach for detection of leprosy.MethodsA cross-sectional study was carried out to evaluate the additional benefits of using several case detection methods in addition to routine practice in two north-eastern states of Nigeria. Primary and secondary data were collected from routine practice records and the Nigerian Tuberculosis and Leprosy Control Programme of 2009. The methods evaluated were Rapid Village Survey (RVS), Household Contact Examination (HCE) and Traditional Healers incentive method (TH). Effectiveness was measured as number of new leprosy cases detected and cost-effectiveness was expressed as cost per case detected. Costs were measured from both providers' and patients' perspectives. Additional costs and effects of each method were estimated by comparing each method against routine practise and expressed as incremental cost-effectiveness ratio (ICER). All costs were converted to the U.S. dollar at the 2010 exchange rate. Univariate sensitivity analysis was used to evaluate uncertainties around the ICER.ResultsThe ICER for HCE was $142 per additional case detected at all contact levels and it was the most cost-effective method. At ICER of $194 per additional case detected, THs method detected more cases at a lower cost than the RVS, which was not cost-effective at $313 per additional case detected. Sensitivity analysis showed that varying the proportion of shared costs and subsistent wage for valuing unpaid time did not significantly change the results.ConclusionComplementing routine practice with household contact examination is the most cost-effective approach to identify new leprosy cases and we recommend that, depending on acceptability and feasibility, this intervention is introduced for improved case detection in Northern Nigeria.
Highlights
Leprosy is a communicable disease caused by a bacillus, Mycobacterium Leprae, which can lead to permanent disability among sufferers with significant psychosocial and economic burden
Key targets of strategy for the reduction of burden of leprosy are the timely detection of new cases and prompt treatment with Multi Drug Therapy (MDT), which is the standard treatment for leprosy [6]
Our findings show that at the rate of $142 per additional case detected, the household contact examination was the most costeffective strategy for detecting additional leprosy cases when implemented to complement routine practice
Summary
Leprosy is a communicable disease caused by a bacillus, Mycobacterium Leprae, which can lead to permanent disability among sufferers with significant psychosocial and economic burden. The disease causes skin lesions and nerve damages which progress to deformities of the eyes, hands and feet [1,2]. These physical disabilities are the prominent features of the disease which impose stigmatisation and discrimination on the sufferers [3]. Early identification of the disease is very critical for effective control. This reduces both transmission of M. leprae and prevents disability. There is the need to review detection methods to enhance identification of early cases for effective control and prevention of permanent disability. This study evaluated the cost-effectiveness of three leprosy case detection methods in Northern Nigeria to identify the most cost-effective approach for detection of leprosy
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