02660nas a2200253   4500000000100000008004100001653001800042653001100060653002100071653001800092653001600110653001400126653002600140653002800166653001600194100001700210700001400227245014600241856026000387300000600647490000600653520173300659022001402392       2007                            d10aLeishmaniasis10aHumans10aHealthcare costs10aHealth Policy10aEmergencies10aCutaneous10aCost-Benefit Analysis10aComplementary Therapies10aAfghanistan1 aReithinger R1 aColeman P00aTreating cutaneous leishmaniasis patients in Kabul, Afghanistan: cost-effectiveness of an operational program in a complex emergency setting.  uhttp://download.springer.com/static/pdf/570/art%253A10.1186%252F1471-2334-7-3.pdf?originUrl=http%3A%2F%2Fbmcinfectdis.biomedcentral.com%2Farticle%2F10.1186%2F1471-2334-7-3&token2=exp=1493044216~acl=%2Fstatic%2Fpdf%2F570%2Fart%25253A10.1186%25252F1471-2334  a30 v73 a<p><strong>BACKGROUND: </strong>Although Kabul city, Afghanistan, is currently the worldwide largest focus of cutaneous leishmaniasis (CL) with an estimated 67,500 cases, donor interest in CL has been comparatively poor because the disease is non-fatal. Since 1998 HealthNet TPO (HNTPO) has implemented leishmaniasis diagnosis and treatment services in Kabul and in 2003 alone 16,390 were treated patients in six health clinics in and around the city. The aim of our study was to calculate the cost-effectiveness for the implemented treatment regimen of CL patients attending HNTPO clinics in the Afghan complex emergency setting.</p>

<p><strong>METHODS: </strong>Using clinical and cost data from the on-going operational HNTPO program in Kabul, published and unpublished sources, and discussions with researchers, we developed models that included probabilistic sensitivity analysis to calculate ranges for the cost per disability adjusted life year (DALY) averted for implemented CL treatment regimen. We calculated the cost-effectiveness of intralesional and intramuscular administration of the pentavalent antimonial drug sodium stibogluconate, HNTPO's current CL 'standard treatment'.</p>

<p><strong>RESULTS: </strong>The cost of the standard treatment was calculated to be 27 US dollars (95% C.I. 20-36) per patient treated and cured. The cost per DALY averted per patient cured with the standard treatment was estimated to be approximately 1,200 US dollars (761-1,827).</p>

<p><strong>CONCLUSION: </strong>According to WHO-CHOICE criteria, treatment of CL in Kabul, Afghanistan, is not a cost-effective health intervention. The rationale for treating CL patients in Afghanistan and elsewhere is discussed.</p>
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