Cost-effectiveness of different strategies for screening and treatment ofStrongyloides stercoralisin migrants from endemic countries to the European Union
Por:
Wikman-Jorgensen PE, Llenas-Garcia J, Shedrawy J, Gascon J, Muñoz J, Bisoffi Z and Requena-Mendez A
Publicada:
1 may 2020
Resumen:
Background The best strategy for controlling morbidity due to imported strongyloidiasis in migrants is unclear. We evaluate the cost-effectiveness of six possible interventions. Methods We developed a stochastic Markov chain model. The target population was adult migrants from endemic countries to the European Union; the time horizon, a lifetime and the perspective, that of the health system. Average and incremental cost-effectiveness ratios (ACER and ICER) were calculated as 2016 EUR/life-year gained (LYG). Health interventions compared were: base case (no programme), primary care-based presumptive treatment (PCPresTr), primary care-based serological screening and treatment (PCSerTr), hospital-based presumptive treatment (HospPresTr), hospital-based serological screening and treatment (HospSerTr), hospital-based presumptive treatment of immunosuppressed (HospPresTrim) and hospital-based serological screening and treatment of the immunosuppressed (HospSerTrim). The willingness to pay threshold (WTP) was euro32 126.95/LYG. Results The base case model yielded a loss of 2 486 708.24 life-years and cost EUR 3 238 393. Other interventions showed the following: PCPresTr: 2 488 095.47 life-years (Delta 1 387.23LYG), cost: EUR 8 194 563; ACER: EUR 3573/LYG; PCSerTr: 2 488 085.8 life-years (Delta 1377.57LYG), cost: EUR 207 679 077, ACER: EUR 148 407/LYG; HospPresTr: 2 488 046.17 life-years (Delta 1337.92LYG), cost: EUR 14 559 575; ACER: EUR 8462/LYG; HospSerTr: 2 488 024.33 life-years (Delta 1316.08LYG); cost: EUR 207 734 073; ACER: EUR 155 382/LYG; HospPresTrim: 2 488 093.93 life-years, cost: EUR 1 105 483; ACER: EUR -1539/LYG (cost savings); HospSerTrim: 2 488 073.8 life-years (Delta 1365.55LYG), cost: EUR 4 274 239; ACER: EUR 759/LYG. One-way and probabilistic sensitivity analyses were undertaken; HospPresTrim remained below WTP for all parameters' ranges and iterations. Conclusion Presumptively treating all immunosuppressed migrants from areas with endemicStrongyloideswould generate cost savings to the health system.
Filiaciones:
:
Medicina Interna, Hospital Universitari San Juan de Alicante, San Juan de Alicante, Alicante, Spain
Foundation for the Promotion of the Research in Healthcare and Biomedicine, Valencia, Spain
:
Medicina Interna/Enfermedades Infecciosas, Hospital Vega Baja-FISABIO, San Bartolome-Orihuela, Alicante, Spain
Clinical Medicine, Universidad Miguel Hernandez de Elche Facultad de Medicina, Sant Joan D'Alacant, Spain
Shedrawy J:
Public Health, Karolinska Institutet, Stockholm, Stockholm County, Sweden
Gascon J:
ISGlobal, Barcelona, Catalunya, Spain
Muñoz J:
ISGlobal, Barcelona, Catalunya, Spain
Bisoffi Z:
Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Veneto, Italy
Diagnostics and Public Health, University of Verona, Verona, Veneto, Italy
Requena-Mendez A:
Instituto de Salud Global Barcelona, Barcelona, Spain
Division of Infectious Diseases, Department of Medicine-Solna, Karolinska Institutet, Stockholm, Sweden
Green Published, gold
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