Cost of Pediatric Visceral Leishmaniasis Care in Morocco

Abstract

Background: Visceral leishmaniasis (VL) is a neglected parasitic disease that is fatal if left untreated. VL is endemic in Morocco and other countries in North Africa were it mainly affects children from rural areas. In Morocco, the direct observation of Leishmania parasites in bone marrow aspirates and serological tests are used to diagnose VL. Glucantime is the first line of treatment. The objective of this study was to report the costs associated to standard clinical management of pediatric VL from the provider perspective in Morocco. As a secondary objective we described the current clinical practices and the epidemiological characteristics of pediatric VL patients.

Methods: From March to June 2014 we conducted a survey in eight hospitals treating pediatric VL patients in Morocco. A pro-forma was used to collect demographic, clinical and management data from medical records. We specifically collected data on VL diagnosis and treatment. We also estimated the days of hospitalization and the time to start VL treatment. Costs were estimated by multiplying the use of resources in terms of number of days in hospital, tests performed and drugs provided by the official prices. For patients receiving part of their treatment at Primary Health Centers (PHC) we estimated the cost of administering the Glucantime as outpatient. We calculated the median cost per VL patient. We also estimated the cost of managing a VL case when different treatment strategies were applied: inpatient and outpatient.

Results: We obtained data from 127 VL patients. The median total cost per pediatric VL case in Morocco is 520 US$. The cost in hospitals applying an outpatient strategy is significantly lower (307 US$) than hospitals keeping the patients for the whole treatment (636 US$). However the outpatient strategy is not yet recommended as VL treatment for children in the Moroccan guidelines. VL diagnosis and treatment regimens should be standardized following the current guidelines in Morocco.

Fig 1

(A) Map of North Morocco showing the distribution of visceral leishmaniasis (VL) cases reported per province from 2003 to 2012. (B) The ten provinces with the highest number of VL cases reported from 2003 to 2012 highlighted in red and the 8 Hospitals selected for the cost study identified with a star. Map generated with QGIS 2.2.0-Valmiera and geographical data from GADM (http://www.gadm.org/).

Fig 2. Tornado diagram presenting the results of the univariate sensitivity analysis.

Changes on the median cost per pediatric Visceral Leishmaniasis (VL) patient were evaluated by shifting (1) the discount rate (from 0% to 5%, base case %), (2) the cost of a vial of Glucantime (from US$ 1.2 to US$ 3.4, base case US$ 1.70) and (3) the cost of administering Glucantime at the Primary Health Centre (PHC) (from US$ 0.62 to US$ 0.99, base case US$ 0.90).