PMD28 Cost-Effectiveness Analysis of Three Leprosy Case Detection Methods in Northern Nigeria

Abstract

Case detection is key to identifying leprosy disease early in its development for more effective prevention of progression to permanent disability. The study evaluated the costs and cost-effectiveness of three leprosy case detection methods in Nigeria's north-eastern states of Adamawa and Gombe; namely Rapid Village Survey (RVS), Household Contact Examination (HCE) and Traditional Healer's (THs) incentive approach The study was cross-sectional and explorative, undertaken in routine practice setting, targeting endemic and non-endemic communities selected randomly. Primary and secondary data were collected from routine practice records and the Nigerian Leprosy Elimination Programme 2009. All costs were measured from both providers' and patients' perspectives. Effectiveness was measured as new cases detected and outcome expressed as cost per case detected. Incremental approach, using routine passive case detection method as a reference was used to estimate the costs and effects by comparing each method against the routine practise; to measure additional cost per new case detected, as incremental cost-effectiveness ratio (ICER). Univariate sensitivity analysis was carried out to evaluate uncertainties around the ICER. All costs were converted to US Dollars at the 2010 exchange rate. HCE generated a total of $2416 at the lowest rate of $142 per additional case detected at all contact levels, as the most cost-effective method while the RVS was dominated by THs method which generated a total of $4447 at $193 per new case detected.Variation of diagnostic accuracy and subsistent wage for valuing unpaid time did not significantly change the results. From both perspectives and at all contact levels, the Household Contact Examination, complementing routine practice demonstrated the most cost-effective approach to identifying new leprosy cases for effective prevention and control of leprosy in Nigeria. It will be necessary to carry out implementation studies to establish the feasibility and acceptability of the method in other leprosy areas.