Abstract
Convergence of geographic regions endemic for human immunodeficiency virus (HIV) and cutaneous leishmaniasis (CL) raise concerns that HIV co-infection may worsen CL burden, complicating already lengthy and costly CL treatments and highlighting a need for newer therapies. We constructed two Markov decision models to quantify impact of HIV on CL and help establish a target product profile for new CL treatments, accounting for co-infection. The HIV co-infection increased lifetime cost per CL case 11–371 times ($1,349–45,683) that of HIV-negative individuals ($123) and Brazil's CL burden from $1.6–16.0 million to $1.6–65.5 million. A new treatment could be a cost saving at ≤ $254 across several ranges (treatments seeking probabilities, side effect risks, cure rates) and continues to save costs up to $508 across treatment-seeking probabilities with a drug cure rate of ≥ 50%. The HIV co-infection can increase CL burden, suggesting more joint HIV and CL surveillance and control efforts are needed.
Highlights
Substantial overlap of the geographic regions endemic for human immunodeficiency virus (HIV) and cutaneous leishmaniasis (CL) infections raise concerns that HIV co-infection may exacerbate the presentation and the economic burden of CL.[1]
Our models focused on Brazil, which accounts for 30% of all HIV cases, 40% of all CL cases in South America,[5,6] and have the most comprehensive countryspecific CL/HIV co-infection data found in the literature
Consideration of HIV co-infection boosted the net present value (NPV) per CL case by 11–371 times to $1,349–45,683 compared with individuals with no co-existing infections ($123). These findings place the total economic burden of CL in Brazil over the lifetime of those currently infected at $3.23–4.38 million, assuming current CL/HIV co-infection rates and CL case estimates from Brazil
Summary
Substantial overlap of the geographic regions endemic for human immunodeficiency virus (HIV) and cutaneous leishmaniasis (CL) infections raise concerns that HIV co-infection may exacerbate the presentation and the economic burden of CL.[1]. Our prior analysis quantified the impact of CL in addition to evaluating the potential cost-effectiveness of a CL vaccine, which could help guide the formulation of the vaccine’s target product profile (TPP),[4] this study did not account for CL/HIV co-infection, a relatively recent phenomenon. Available CL treatments are already lengthy and costly; HIV co-infection further complicates these treatments and highlights the need for newer drug therapies.[2] we developed an economic model of CL with and without HIV co-infection to quantify the impact of HIV co-infection on CL infection and a second model to help establish a TPP for a new CL treatment, accounting for HIV co-infection
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