Centre for Tropical Medicine, University of Brasilia, Brasilia, Federal District, Brazil.
Centre for Tropical Medicine, University of Brasilia, Brasilia, Federal District, Brazil; National Institute for Science and Technology for Health Technology Assessment, Porto Alegre, RS, Brazil.
Value Health Reg Issues. 2020 Dec;23:77-84. doi: 10.1016/j.vhri.2020.05.006. Epub 2020 Sep 19.
To estimate the budget impact of the expansion of liposomal amphotericin B use for all confirmed cases of visceral leishmaniasis (VL) in Brazil. Currently, the first-line medicine for VL treatment is meglumine antimoniate. Liposomal amphotericin B is indicated only for patients with a greater risk of severity by the disease.
The analysis was performed from the perspective of the Brazilian public healthcare system over 3 years, considering the following 2 scenarios: the reference scenario with the current recommendations for VL treatment and the alternative scenario based on the use of liposomal amphotericin B for all patients. A diffusion rate of 60% was used in the first year, 80% in the second year, and 100% in the third year. The epidemiological parameters used in the analysis came from the Notifiable Diseases Information System and from a clinical trial that evaluated the efficacy and safety of medicines for the treatment of VL in the country. The costs were related to the treatment of VL and to hospital and outpatient care.
In the reference scenario, the total cost for treatment of the 3453 VL confirmed cases in 2014 was $1 447 611.75. The incremental budget impact with the use of liposomal amphotericin B for all the VL confirmed cases was $299 646.43 in the third year.
The analysis presented will support the decision process for the use and expansion of liposomal amphotericin B for all VL confirmed cases in Brazil.
估算在巴西将两性霉素 B 脂质体用于所有确诊内脏利什曼病（VL）病例的预算影响。目前，VL 的一线治疗药物是葡甲胺锑酸钠。两性霉素 B 脂质体仅用于病情更严重风险较高的患者。
该分析从巴西公共医疗保健系统的角度进行了 3 年的研究，考虑了以下 2 种情况：参考方案是目前 VL 治疗建议，替代方案是将两性霉素 B 脂质体用于所有患者。第一年的扩散率为 60%，第二年为 80%，第三年为 100%。分析中使用的流行病学参数来自法定传染病信息系统和在该国评估治疗 VL 的药物疗效和安全性的临床试验。成本与 VL 的治疗以及医院和门诊护理有关。
在参考方案中，2014 年 3453 例 VL 确诊病例的总治疗费用为 1447611.75 美元。在第三年，使用两性霉素 B 脂质体治疗所有 VL 确诊病例的增量预算影响为 299646.43 美元。
本分析将支持巴西使用和扩大两性霉素 B 脂质体用于所有 VL 确诊病例的决策过程。
