Cost-effectiveness of a chemoprophylactic intervention with single dose rifampicin in contacts of new leprosy patients.

Willemijn J Idema,David Pahan,Linda Oskam,Jan Hendrik Richardus,Suzanne Polinder,Istvan M Majer

doi:10.1371/journal.pntd.0000874

Abstract

BackgroundWith 249,007 new leprosy patients detected globally in 2008, it remains necessary to develop new and effective interventions to interrupt the transmission of M. leprae. We assessed the economic benefits of single dose rifampicin (SDR) for contacts as chemoprophylactic intervention in the control of leprosy.MethodsWe conducted a single centre, double blind, cluster randomised, placebo controlled trial in northwest Bangladesh between 2002 and 2007, including 21,711 close contacts of 1,037 patients with newly diagnosed leprosy. We gave a single dose of rifampicin or placebo to close contacts, with follow-up for four years. The main outcome measure was the development of clinical leprosy. We assessed the cost effectiveness by calculating the incremental cost effectiveness ratio (ICER) between the standard multidrug therapy (MDT) program with the additional chemoprophylaxis intervention versus the standard MDT program only. The ICER was expressed in US dollars per prevented leprosy case.FindingsChemoprophylaxis with SDR for preventing leprosy among contacts of leprosy patients is cost-effective at all contact levels and thereby a cost-effective prevention strategy. In total, $6,009 incremental cost was invested and 38 incremental leprosy cases were prevented, resulting in an ICER of $158 per one additional prevented leprosy case. It was the most cost-effective in neighbours of neighbours and social contacts (ICER $214), slightly less cost-effective in next door neighbours (ICER $497) and least cost-effective among household contacts (ICER $856).ConclusionChemoprophylaxis with single dose rifampicin given to contacts of newly diagnosed leprosy patients is a cost-effective intervention strategy. Implementation studies are necessary to establish whether this intervention is acceptable and feasible in other leprosy endemic areas of the world.

Highlights

Leprosy is a chronic infectious disease, caused by the bacillus Mycobacterium leprae, which affects the skin and peripheral nerves leading to skin lesions, loss of sensation, and nerve damage
Chemoprophylaxis with single dose rifampicin given to contacts of newly diagnosed leprosy patients is a costeffective intervention strategy
An important assumption underlying the World Health Organisation (WHO) leprosy elimination strategy was that multidrug therapy (MDT) would reduce transmission of M. leprae through a reduction of the number of contagious individuals in the community [3]

Summary

Introduction

Leprosy is a chronic infectious disease, caused by the bacillus Mycobacterium leprae, which affects the skin and peripheral nerves leading to skin lesions, loss of sensation, and nerve damage. This in turn can lead to secondary impairments or deformities of the eyes, hands and feet. The WHO elimination strategy was based on increasing the geographical coverage of MDT and patients’ accessibility to the treatment. An important assumption underlying the WHO leprosy elimination strategy was that MDT would reduce transmission of M. leprae through a reduction of the number of contagious individuals in the community [3]. We assessed the economic benefits of single dose rifampicin (SDR) for contacts as chemoprophylactic intervention in the control of leprosy

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Results

Discussion

Conclusion