Cost-effectiveness analysis of combined active and passive versus passive leprosy case detection alone in Thailand

Abstract

To analyze the cost and effectiveness of different case finding activities: Combined active and passive leprosy case detection (ACD and PCD) versus passive leprosy case detection alone (PCD) for the year 2006 in Thailand, from provider as well as patient perspectives. In this study, effectiveness in terms of new cases detected is used to find out which method of case finding activity is better. The cost-effectiveness ratios are calculated for non-endemic and endemic areas. The total cost, from the provider perspective, of the combined ACD and PCD method was 1,427,800.23 Baht and the number of newly detected cases 35. The cost-effectiveness ratio was 40,794.29 Baht. In non-endemic areas, the cost-effectiveness ratio was 42,521.15 Baht. In endemic areas, the cost-effectiveness ratio was 39,340.10 Baht. The total cost, from provider perspective, of the PCD alone method was 1,340,230.20 Baht, with 16 newly detected cases. The cost-effectiveness ratio was 83,764.39 Baht. In non-endemic areas, the cost-effectiveness ratio was 92,563.55 Baht. In endemic areas, the cost-effectiveness ratio was 74,965.23 Baht. The total costs from a patient perspective were similar in both methods, but 2.2 times higher in non-endemic areas than in endemic areas. The cost-effectiveness ratio of the combined ACD and PCD method in non-endemic area and in endemic area was 1,361.18 Baht and 231.50 Baht respectively. The cost-effectiveness ratio of the PCD alone method in non-endemic areas was 1,345.33 Baht and in endemic areas was 816 Baht. The study concludes that the combined ACD and PCD method is more cost-effective than the PCD alone method in both methods. Therefore, the leprosy control program should focus on combined ACD and PCD method more than on the PCD alone method.