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Eid, Daniel
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Publications (5 of 5) Show all publications
Eid Rodríguez, D., San Sebastian, M. & Pulkki-Brännström, A.-M. (2019). "Cheaper and better": Societal cost savings and budget impact of changing from systemic to intralesional pentavalent antimonials as the first-line treatment for cutaneous leishmaniasis in Bolivia. PLoS Neglected Tropical Diseases, 13(11), Article ID e0007788.
Open this publication in new window or tab >>"Cheaper and better": Societal cost savings and budget impact of changing from systemic to intralesional pentavalent antimonials as the first-line treatment for cutaneous leishmaniasis in Bolivia
2019 (English)In: PLoS Neglected Tropical Diseases, ISSN 1935-2727, E-ISSN 1935-2735, Vol. 13, no 11, article id e0007788Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Cutaneous leishmaniasis (CL), endemic in Bolivia, mostly affects poor people in rainforest areas. The current first-line treatment consists of systemic pentavalent antimonials (SPA) for 20 days and is paid for by the Ministry of Health (MoH). Long periods of drug shortages and a lack of safe conditions to deliver treatment are challenges to implementation. Intralesional pentavalent antimonials (ILPA) are an alternative to SPA. This study aims to compare the cost of ILPA and SPA, and to estimate the health and economic impacts of changing the first-line treatment for CL in a Bolivian endemic area.

METHODS: The cost-per-patient treated was estimated for SPA and ILPA from the perspectives of the MoH and society. The quantity and unit costs of medications, staff time, transportation and loss of production were obtained through a health facility survey (N = 12), official documents and key informants. A one-way sensitivity analysis was conducted on key parameters to evaluate the robustness of the results. The annual number of patients treated and the budget impact of switching to ILPA as the first-line treatment were estimated under different scenarios of increasing treatment utilization. Costs were reported in 2017 international dollars (1 INT$ = 3.10 BOB).

RESULTS: Treating CL using ILPA was associated with a cost-saving of $248 per-patient-treated from the MoH perspective, and $688 per-patient-treated from the societal perspective. Switching first-line treatment to ILPA while maintaining the current budget would allow two-and-a-half times the current number of patients to be treated. ILPA remained cost-saving compared to SPA in the sensitivity analysis.

CONCLUSIONS: The results of this study support a shift to ILPA as the first-line treatment for CL in Bolivia and possibly in other South American countries.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-165123 (URN)10.1371/journal.pntd.0007788 (DOI)31693661 (PubMedID)
Funder
Sida - Swedish International Development Cooperation Agency
Available from: 2019-11-11 Created: 2019-11-11 Last updated: 2019-11-12Bibliographically approved
Eid, D., San Sebastian, M., Hurtig, A.-K. & Goicolea, I. (2019). Leishmaniasis patients' pilgrimage to access health care in rural Bolivia: a qualitative study using human rights to health approach. BMC International Health and Human Rights, 19(1), Article ID 12.
Open this publication in new window or tab >>Leishmaniasis patients' pilgrimage to access health care in rural Bolivia: a qualitative study using human rights to health approach
2019 (English)In: BMC International Health and Human Rights, ISSN 1472-698X, E-ISSN 1472-698X, Vol. 19, no 1, article id 12Article in journal (Refereed) Published
Abstract [en]

Background: Leishmaniasis is a neglected tropical disease endemic in Bolivia that disproportionately affects people with little social and political capital. Although the treatment is provided free of charge by the Bolivian government, there is an under-utilization of treatments in relation to the estimated affected population. This study explores the experiences of patients with leishmaniasis and the challenges faced when searching for diagnosis and treatment in Bolivia using a human rights approach.

Methods: We conducted open-ended interviews with 14 participants diagnosed with leishmaniasis. The qualitative data were analysed using thematic analysis and were interpreted under a human rights approach to health care.

Results: Four themes emerged during data analysis: (1) the decision for seeking a cure takes time; (2) the severity of symptoms and disruption of functioning drives the search for Western medicine; (3) the therapeutic journey between Western and traditional medicine; and (4) accessibility barriers to receive adequate medical treatment. This study showed that access to health care limitations were the most important factors that prevented patients from receiving timely diagnosis and treatment. Cultural factors played a secondary role in their decision to seek medical care.

Conclusions: Accessibility barriers resulted in a large pilgrimage between public health care and traditional medicinal treatments for patients with leishmaniasis. This pilgrimage and the related costs are important factors that determine the decision to seek health care. This study contributes to the understanding of the under-utilisation problems of medical services in leishmaniasis and other similar diseases in remote and poor populations.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Cutaneous leishmaniasis, human rights, health care, seeking behavior, Bolivia
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-156786 (URN)10.1186/s12914-019-0196-4 (DOI)000460652900002 ()30837001 (PubMedID)
Funder
Sida - Swedish International Development Cooperation Agency, 75000554
Available from: 2019-02-28 Created: 2019-02-28 Last updated: 2019-04-08Bibliographically approved
Eid, D., Guzman-Rivero, M., Rojas, E., Goicolea, I., Hurtig, A.-K., Illanes, D. & San Sebastian, M. (2018). Assessment of a Leishmaniasis Reporting System in Tropical Bolivia Using the Capture-Recapture Method. American Journal of Tropical Medicine and Hygiene, 98(1), 134-138
Open this publication in new window or tab >>Assessment of a Leishmaniasis Reporting System in Tropical Bolivia Using the Capture-Recapture Method
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2018 (English)In: American Journal of Tropical Medicine and Hygiene, ISSN 0002-9637, E-ISSN 1476-1645, Vol. 98, no 1, p. 134-138Article in journal (Refereed) Published
Abstract [en]

This study evaluates the level of underreporting of the National Program of Leishmaniasis Control (NPLC) in two communities of Cochabamba, Bolivia during the period 2013-2014. Montenegro skin test-confirmed cases of cutaneous leishmaniasis (CL) were identified through active surveillance during medical campaigns. These cases were compared with those registered in the NPLC by passive surveillance. After matching and cleaning data from the two sources, the total number of cases and the level of underreporting of the National Program were calculated using the capture-recapture analysis. This estimated that 86 cases of CL (95% confidence interval [CI]: 62.1-110.8) occurred in the study period in both communities. The level of underreporting of the NPLC in these communities was very high: 73.4% (95% CI: 62.1-110.8). These results can be explained by the inaccessibility of health services and centralization of the NPLC activities. This information is important to establish priorities among policy-makers and funding organizations as well as implementing adequate intervention plans.

Place, publisher, year, edition, pages
The American Society of Tropical Medicine and Hygiene, 2018
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-142487 (URN)10.4269/ajtmh.17-0308 (DOI)000430950900025 ()29141751 (PubMedID)2-s2.0-85040512633 (Scopus ID)
Available from: 2017-11-30 Created: 2017-11-30 Last updated: 2019-03-13Bibliographically approved
Eid, D., Guzman-Rivero, M., Rojas, E., Goicolea, I., Hurtig, A.-K., Illanes, D. & San Sebastian, M. (2018). Risk factors for cutaneous leishmaniasis in the rainforest of Bolivia: a cross-sectional study. Tropical Medicine and Health, 46, Article ID 9.
Open this publication in new window or tab >>Risk factors for cutaneous leishmaniasis in the rainforest of Bolivia: a cross-sectional study
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2018 (English)In: Tropical Medicine and Health, ISSN 1348-8945, E-ISSN 1349-4147, Vol. 46, article id 9Article in journal (Refereed) Published
Abstract [en]

Background: Cutaneous leishmaniasis (CL) is an endemic disease in Bolivia, particularly in the rainforest of Cochabamba, in the municipality of Villa Tunari. The precarious, dispersed, and poorly accessible settlements in these farming communities make it difficult to study them, and there are no epidemiological studies in the area. The aim of the present study was to identify the risk factors associated with cutaneous leishmaniasis.

Methods: A cross-sectional study was conducted in August 2015 and August 2016 in two communities of Villa Tunari, Cochabamba. The cases were diagnosed through clinical examinations, identification of the parasite by microscopic examination, and the Montenegro skin test. Risk factors were identified through logistic regression.

Results: A total of 274 participants (40.9% female and 59.1% male) were surveyed, of which 43% were CL positive. Sex was the only factor associated with CL with three times more risk for men than for women; this finding suggests a sylvatic mechanism of transmission in the area.

Conclusions: It is advisable to focus on education and prevention policies at an early age for activities related to either leisure or work. Further research is needed to assess the influence of gender-associated behavior for the risk of cutaneous leishmaniasis.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-147457 (URN)10.1186/s41182-018-0089-6 (DOI)000430564000001 ()29692654 (PubMedID)
Available from: 2018-05-29 Created: 2018-05-29 Last updated: 2019-03-11Bibliographically approved
Eid, D., San Sebastian, M. & Pulkki-Brännström, A.-M. "Cheaper and better": an economic analysis of changing first line treatment for cutaneous leishmaniasis in Bolivia.
Open this publication in new window or tab >>"Cheaper and better": an economic analysis of changing first line treatment for cutaneous leishmaniasis in Bolivia
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction: Cutaneous leishmaniasis (CL) is endemic in Bolivia, mostly affecting poor people in rainforest areas. The current first-line treatment consists of systemic pentavalent antimonials (SPA) for 20 days and is paid for by the Ministry of Health (MoH). Long periods of drug shortages, a lack of conditions to deliver treatment safely, treatment interruption are challenges to implementation. Intralesional pentavalent antimonials (ILPA) are an alternative to SPA. This study aims to compare the cost of ILPA and SPA, and to estimate the health and economic impacts of changing the first-line treatment for CL in an endemic area of Bolivia.

Methods: The cost per patient treated was estimated for SPA and ILPA from the perspectives of the MoH and society. The quantity and unit costs of medications, staff time, transportation and loss of production were obtained through a health facility survey (N=12), official documents and key informants. A one-way sensitivity analysis was conducted on key parameters to evaluate the robustness of the results. The annual number of patients treated and the budget impact of switching to ILPA as the first-line treatment were estimated under different scenarios of increasing treatment utilization using previous estimates of the extent of underreporting. Costs were reported in 2016 international dollars (1 INT$ = 3.10 BOB).

Results: Treating CL using ILPA was associated with a cost saving of $248 per patient treated from the MoH perspective, and $688 per patient treated from the societal perspective. ILPA was cost-saving even under a hypothetical increase of 80% in the number of cases treated. Switching first-line treatment would allow two-and-a-half times the current number of patients to be treated, while maintaining the current budget.

Conclusions: The results of this study support a shift to ILPA as the first-line treatment for CL in Bolivia and possibly in other South American countries.

Keywords
Cutaneous leishmaniasis, economic analysis, intralesional pentavalent antimonials, Bolivia, cost analysis
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
urn:nbn:se:umu:diva-156787 (URN)
Funder
Sida - Swedish International Development Cooperation Agency, 75000554
Available from: 2019-02-26 Created: 2019-02-26 Last updated: 2019-03-19
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