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Cost-Effectiveness of Interventions to Prevent Disability in Leprosy: A Systematic Review

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  • Natasja H J van Veen
  • Paul McNamee
  • Jan Hendrik Richardus
  • W Cairns S Smith

Abstract

Background: Prevention of disability (POD) is one of the key objectives of leprosy programmes. Recently, coverage and access have been identified as the priority issues in POD. Assessing the cost-effectiveness of POD interventions is highly relevant to understanding the barriers and opportunities to achieving universal coverage and access with limited resources. The purpose of this study was to systematically review the quality of existing cost-effectiveness evidence and discuss implications for future research and strategies to prevent disability in leprosy and other disabling conditions. Methodology/Principal Findings: We searched electronic databases (NHS EED, MEDLINE, EMBASE, and LILACS) and databases of ongoing trials (www.controlled-trials.com/mrct/, www.who.int/trialsearch). We checked reference lists and contacted experts for further relevant studies. We included studies that reported both cost and effectiveness outcomes of two or more alternative interventions to prevent disability in leprosy. We assessed the quality of the identified studies using a standard checklist for critical appraisal of economic evaluations of health care programmes. We found 66 citations to potentially relevant studies and three met our criteria. Two were randomised controlled trials (footwear, management of neuritis) and one was a generic model-based study (cost per DALY). Generally, the studies were small in size, reported inadequately all relevant costs, uncertainties in estimates, and issues of concern and were based on limited data sources. No cost-effectiveness data on self-care, which is a key strategy in POD, was found. Conclusion/Significance: Evidence for cost-effectiveness of POD interventions for leprosy is scarce. High quality research is needed to identify POD interventions that offer value for money where resources are very scarce, and to develop strategies aimed at available, affordable and sustainable quality POD services for leprosy. The findings are relevant for other chronically disabling conditions, such as lymphatic filariasis, Buruli ulcer and diabetes in developing countries.

Suggested Citation

  • Natasja H J van Veen & Paul McNamee & Jan Hendrik Richardus & W Cairns S Smith, 2009. "Cost-Effectiveness of Interventions to Prevent Disability in Leprosy: A Systematic Review," PLOS ONE, Public Library of Science, vol. 4(2), pages 1-7, February.
    • Handle: RePEc:plo:pone00:0004548
    DOI: 10.1371/journal.pone.0004548
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    References listed on IDEAS

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    1. Alan D. Lopez & Colin D. Mathers & Majid Ezzati & Dean T. Jamison & Christopher J. L. Murray, 2006. "Global Burden of Disease and Risk Factors," World Bank Publications - Books, The World Bank Group, number 7039.
    2. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
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    1. Anuj Tiwari & David J Blok & Mohammad Arif & Jan Hendrik Richardus, 2020. "Leprosy post-exposure prophylaxis in the Indian health system: A cost-effectiveness analysis," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 14(8), pages 1-12, August.
    2. Charles Ezenduka & Erik Post & Steven John & Abdulkarim Suraj & Abdulahi Namadi & Obinna Onwujekwe, 2012. "Cost-Effectiveness Analysis of Three Leprosy Case Detection Methods in Northern Nigeria," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 6(9), pages 1-8, September.

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