Comparative cost-effectiveness of intralesional meglumine antimoniate alone versus cryotherapy plus intralesional meglumine antimoniate in cutaneous leishmaniasis: Experience from a high capacity dermatology centre

Abstract

Background There is a high prevalence of cutaneous leishmaniosis (CL) in southern Khyber Pakhtunkhwa and most patients present late. Conventional treatment takes longer and hence patients loose adherence to their treatment. Recently cryotherapy has been shown to speed up lesion healing with lower chemotherapeutic drug requirements. Aim To compare the cost-effectiveness of intralesional meglumine antimoniate (MA) alone and cryotherapy plus intralesional MA for CL in terms of overall effectiveness, time to healing and its impact on patient adherence from a poor Pakistani community. Methods Prospective randomised study with two treatment arms. Group A included patients treated with standard intralesional MA alone and group B included patients treated with cryotherapy plus intralesional MA. Data was collected for time to healing of the lesions; total direct treatment cost and overall effectiveness. Both treatment arms were also compared in the failure and success rates. Results The overall mean age was 15.06 ± 14.23 years with a mean duration of the lesion appearance of 4.5 ± 2.1 weeks (range: 1-9 weeks). The mean surface area of the lesions was 2.6 ± 0.7 cm2. There were 84 (62.7%) males and 50 (37.3%) females in a ratio of 1.6 to 1. The overall mean time to healing was 19.7 ± 9.1 days with a mean treatment sessions of 2.8 ± 1.07. The mean overall direct cost of treatment was 4364.2 ± 2180.31 rupees. At the end of the study, there were 44 (32.8%) cases of treatment failures. Of these, 29 (21.6%) were from group A and 15 (11.2%) were from group B (p = 0.005). An independent samples t-test showed that there were significant mean differences for time to healing, number of treatment sessions required until healing and the direct total cost of treatment (p <0.0001). Conclusions Cryotherapy in combination with intralesional antimonials is highly effective. The effectiveness of cryotherapy is more pronounced when the cost of the treatment is considered for the poor population that is afflicted with this condition. Lower treatment costs enhances higher follow-up rate and shorter treatment duration.