Mistro Sóstenes, Gomes Bárbara, Rosa Lorena, Miranda Ligia, Camargo Marianne, Badaró Roberto
Multidisciplinary Institute of Health, Federal University of Bahia, Vitória da Conquista, Brazil.
Program of Post-Graduation in Medicine and Health, Federal University of Bahia, Salvador, Brazil.
Trop Med Int Health. 2017 Dec;22(12):1569-1578. doi: 10.1111/tmi.12996. Epub 2017 Nov 22.
To compare the cost-effectiveness of L-AmB with that of Sb and AmB-D, for the treatment of mucocutaneous leishmaniasis in a hospital in north-east Brazil.
We developed an economic model based on retrospective data of 73 hospitalised patients in 2006-2012, from hospital and public health system perspectives.
In the economic model, 82.2% of patients who started treatment with L-AmB had completed it after 2 months, vs. 22.0% for the Sb and 19.9% for the AmB-D groups. After 12 months of follow-up, these proportions were 100% in the L-AmB, 77.4% in the AmB-D and 72.2% in the Sb group. Markov chain analyses showed that the group that started therapy with Sb had the lowest mean total cost (US$ 3782.38), followed by AmB-D (US$ 5211.27) and L-AmB (US$ 11 337.44). The incremental cost-effectiveness ratio for L-AmB was US$ 18 816.23 against Sb and US$ 24 504.65 against AmB-D. In the sensitivity analysis, the drug acquisition cost of L-AmB significantly influenced the results.
In the treatment of mucocutaneous leishmaniasis, L-AmB is a cost-effective alternative to Sb and AmB-D owing to its higher effectiveness, safety and shorter course.
比较脂质体两性霉素B（L-AmB）与斯锑黑克（Sb）和两性霉素B去氧胆酸盐（AmB-D）治疗巴西东北部一家医院黏膜皮肤利什曼病的成本效益。
我们基于2006 - 2012年73例住院患者的回顾性数据，从医院和公共卫生系统角度建立了一个经济模型。
在经济模型中，开始使用L-AmB治疗的患者中有82.2%在2个月后完成了治疗，而Sb组为22.0%，AmB-D组为19.9%。随访12个月后，L-AmB组这一比例为100%，AmB-D组为77.4%，Sb组为72.2%。马尔可夫链分析表明，开始使用Sb治疗的组平均总成本最低（3782.38美元），其次是AmB-D组（5211.27美元）和L-AmB组（11337.44美元）。L-AmB相对于Sb的增量成本效益比为18816.23美元，相对于AmB-D为24504.65美元。在敏感性分析中，L-AmB的药品采购成本对结果有显著影响。
在治疗黏膜皮肤利什曼病方面，由于L-AmB具有更高的有效性、安全性和更短的疗程，它是Sb和AmB-D的一种具有成本效益的替代药物。
