Economic evaluation of high-dose versus standard-dose rifampicin for the treatment of Buruli Ulcer in Ghana

Background:

Neglected Tropical Diseases (NTDs) are endemic in Africa, accounting for about 40% of the disease burden in the region. Buruli Ulcer (BU) is a prominent NTD caused by Mycobacterium ulcerans. Without effective treatment, it can lead to lifelong disability and deformities, creating a substantial health and economic burden. Currently, BU is treated with oral antibiotics (standard-dose rifampicin [SR, 10mg/kg] and clarithromycin [15mg/kg]) and wound care (vaseline gauze). High-dose rifampicin [HR] (20mg/kg) combined with clarithromycin could shorten the treatment duration and improve healing. However, little is known about the costs of experiencing or treating BU or the cost-effectiveness of these alternative treatment regimes. We aimed to evaluate the costs and cost-effectiveness of HR vs. SR treatment for BU within a multicentre, individually randomized controlled trial at two hospitals in Ghana.   

Methods:

We conducted the study at Pakro in the Eastern region and Wassa Akropong in the Western region of Ghana. The trial period was from November 2021 to 31 July 2024. Enrolled patients were followed up for 12 months from treatment initiation. Data were structured in three phases (demographic, patient cost, and health provider cost) and were collected from patients, providers, and project records at enrolment and follow-up points. Quality-adjusted life-years (QALYs) and clinical scores were used to measure the effectiveness of the trial. Cost variation per patient, across households, socio-demographic characteristics, clinical disease stages, wealth status, and trial arm was explored.