Kruchten Stephanie D, Bacon Kristina M, Lee Bruce Y
Am J Trop Med Hyg. 2014 Sep;91(3):520-527. doi: 10.4269/ajtmh.13-0309. Epub 2014 Jul 7.
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.
人类免疫缺陷病毒（HIV）和皮肤利什曼病（CL）的地方性流行地理区域相互重叠，这引发了人们的担忧，即HIV合并感染可能会加重CL负担，使本就漫长且昂贵的CL治疗变得更加复杂，并凸显了对新型疗法的需求。我们构建了两个马尔可夫决策模型，以量化HIV对CL的影响，并帮助确定针对新的CL治疗方法的目标产品概况，同时考虑合并感染情况。HIV合并感染使每例CL病例的终身成本增加了11至371倍（1349美元至45683美元），而HIV阴性个体的成本为123美元，并且巴西的CL负担从160万美元至1600万美元增加到160万美元至6550万美元。一种新的治疗方法在几个范围内（寻求治疗的概率、副作用风险、治愈率）成本节省≤254美元时可能具有成本效益，并且在药物治愈率≥50%的情况下，在寻求治疗的概率范围内持续节省成本高达508美元。HIV合并感染会增加CL负担，这表明需要更多针对HIV和CL的联合监测与控制措施。
