Cost-effectiveness of a canine visceral leishmaniasis control program in Brazil based on insecticide-impregnated collars

Assis, Tália Machado de; Azeredo-da-Silva, André Luís Ferreira de; Cota, Gláucia; Rocha, Marília Fonseca; Werneck, Guilherme Loureiro

doi:10.1590/0037-8682-0680-2020

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Major Article • Rev. Soc. Bras. Med. Trop. 53 • 2020 • https://doi.org/10.1590/0037-8682-0680-2020 copy

Cost-effectiveness of a canine visceral leishmaniasis control program in Brazil based on insecticide-impregnated collars

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

INTRODUCTION:

The use of insecticide-impregnated dog collars is a potentially useful tool for the control of visceral leishmaniasis. The objective of the present study was to perform a cost-effectiveness analysis of a program based on insecticide-impregnated collars compared to traditional visceral leishmaniasis control strategies used in Brazil.

METHODS:

A cost-effectiveness analysis was performed from the perspective of the Unified Health System, using data from the Visceral Leishmaniasis Control Program implemented in the municipality of Montes Claros, Minas Gerais. The direct costs of the three control strategies, which were 1) canine infection screening + sacrifice, 2) residual chemical control of the vector, and 3) insecticide-impregnated dog collars (Scalibor^®), were evaluated over the two-year study period.

RESULTS:

The total cost of the program in the area subjected to the traditional control strategies (strategies 1 and 2; control area) was R$ 1,551,699.80, and in the area subjected to all three control strategies (intervention area), it was R$ 1,898,190.16. The collar program was considered highly cost-effective at preventing canine visceral leishmaniasis (incremental cost-effectiveness ratio of approximately R$ 578 per avoided dog sacrifice).

CONCLUSIONS:

These results provide support for the decision by the Brazilian Ministry of Health in 2019 to provide insecticide-impregnated collars for the control of canine visceral leishmaniasis in a pilot project.

Keywords:
Collars; Visceral leishmaniasis; Cost-effectiveness

Characteristics	Control area	Intervention area
Population	34,736	32,334
Total number of dogs examined by DPP^® and collared	17,716	22,016
Total number of dogs examined by ELISA	2,795	2,255
Total number of sacrificed dogs	980	962
Total number of properties scheduled for spraying	7,695	10,129
Total number of collared dogs	-	22,016

Control measure	Items included
Canine infection screening + sacrifice	Proportional workers’ wages (Veterinarian, Endemic Diseases Control Agent, Driver, Biologist, and Clinical Pathology Technician), cars, motorcycles, gasoline, clipboards, pencils, pens, erasers, printing, DPP kits, bags, pants, booties, caps, insulated bags, coolers, reusable cool packs, gloves, cords, blood collection tubes, alcohol, needle syringes, cotton, ELISA kits, tips, tubes, pipettes, ELISA readers, microplate washer, incubator, refrigerator, freezer, scale, garbage bag, acepromazine, thiopental, and potassium chloride
Residual chemical control of the vector	Proportional workers’ wages (Endemic Diseases Control Agent and Drivers), cars, gasoline, long-sleeve shirts, pants, boots, full-face masks, filters, nitrile gloves, backpack sprayer, and insecticide
Insecticide-impregnated dog collars	Proportional workers’ wages (Veterinarian and Endemic Diseases Control Agent) and collars

Activities and cost components	Control area					Intervention area
	1^st	2^nd	3^rd	4^th	Total R$	1^st	2^nd	3^rd	4^th	Total
	cycle R$	cycle R$	cycle R$	cycle R$	cycle R$	cycle R$	cycle R$	cycle R$	cycle R$	R$
Canine infection screening - diagnosis by DPP ^b and ELISA ^c
Human resources	49,797.38	55,379.26	50,008.07	52,742.17	207,926.88	54,318.09	50,707.76	50,305.11	63,496.02	218,826.98
PPE^a and uniforms	4,197.06	4,321.52	4,298.40	4,264.46	17,081.44	4,457.02	4,602.72	4,659.10	4,651.24	18,370.08
Transportation	2,468.17	2,262.38	2,581.71	3,169.52	10,481.78	2,432.55	2,296.42	2,846.11	3,654.45	11,229.53
Office supplies	896.11	984.44	968.62	946.05	3,795.22	1,077.07	1,181.58	1,221.67	1,228.46	4,708.78
Materials used in the laboratory	5,711.96	4,871.40	4,499.00	3,504.16	18,586.52	7,058.64	4,729.92	4,546.16	2,985.40	19,320.12
Materials used in the field	29,375.32	32,143.32	31,598.12	30,758.32	123,875.08	35,377.52	38,519.12	39,797.52	39,504.92	153,199.08
Subtotal	92,446.00	99,962.32	93,953.92	95,384.68	381,746.92	104,720.89	102,037.52	103,375.67	115,520.49	425,654.57
Sacrifice of seropositive dogs
Human resources	8,191.68	6,588.96	4,502.88	5,647.68	24,931.2	10,481.28	7,123.20	3,459.84	3,408.96	24,473.28
PPE^a and uniforms	1,041.11	969.29	875.81	927.11	3,813.32	1,143.71	993.23	829.07	864.39	3,830.4
Transportation	1,735.97	1,388.93	1,731.36	1,689.03	6,545.29	1,610.69	1,779.17	1,586.93	1,609.25	6,586.04
Office supplies	27.18	31.38	28.44	32.22	119.22	25.92	25.92	25.50	54.54	131.88
Material used in kennels	2,257.22	1,815.59	1,240.77	1,556.22	6,869.8	2,888.12	1,962.80	953.36	939.34	6,743.62
Subtotal	13,253.16	10,794.15	8,379.26	9,852.26	42,278.83	16,149.72	11,884.32	6,854.70	6,876.48	41,765.22
Residual chemical control
Human resources	222,315.23	222,315.23	222,315.23	222,315.23	889,260.92	216,135.56	216,135.56	216,135.56	216,135.56	864,542.24
PPE^a and uniforms	5,045.57	5,045.57	5,045.57	5,045.57	20,182.28	3,833.72	3,833.72	3,833.72	3,833.72	15,334.88
Transportation	4,589.66	4,589.66	4,589.66	4,589.66	18,358.64	3,393.88	3,393.88	3,393.88	3,393.88	13,575.52
Office supplies	796.51	796.51	796.51	796.51	3,186.04	609.93	609.93	609.93	609.93	2439.72
Insecticide	49,478.85	49,478.85	49,478.85	49,478.85	197,915.4	65,129.5	65,129.5	65,129.5	65,129.5	260.518.0
Subtotal	282,225.8	282,225.8	282,225.8	282,225.8	1,128,903.2	289,102.59	289,102.59	289,102.59	289,102.59	1,156,410.36
Dog collaring
Human resources	-	-	-	-		4,281.45	4,707.3	4,869.65	4,855.20	18,713.60
Collars	-	-	-	-		60,292.89	66,289.86	68,576.13	68,372.64	263,531.52
Subtotal						64,574.34	70,997.16	73,445.78	73,227.84	282,245.12
Total	387,924.95	387,924.95	387,924.95	387,924.95	1,551,699.8	474,547.54	474,547.54	474,547.54	474,547.54	1,898,190.16

Strategies	Cost (R$)	Incremental	Effectiveness	Incremental	*ICER - no**	*ICER - with an**
		cost (R$)	(dogs without VL)	effectiveness	discount (R$/case of	overall discount
					avoided canine VL)	of 5%/year
Canine infection	3,025,828.39	-	90,052.19	-	-	-
screening +
euthanasia +
chemical control
Canine infection	4,102,934.72	1,077,106.33	91,913.86	1,861.67	569.47	578.57
screening +
euthanasia +
chemical control
+ dog collaring

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[1] Corresponding author: Tália Machado de Assis. e-mail:talia@cefetmg.br