Cost-effectiveness and social outcomes of a community-based treatment for podoconiosis lymphoedema in the East Gojjam zone, Ethiopia.
Journal
PLoS neglected tropical diseases
ISSN: 1935-2735
Titre abrégé: PLoS Negl Trop Dis
Pays: United States
ID NLM: 101291488
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
15
04
2019
accepted:
13
09
2019
entrez:
24
10
2019
pubmed:
24
10
2019
medline:
6
2
2020
Statut:
epublish
Résumé
Podoconiosis is a disease of the lymphatic vessels of the lower extremities that is caused by chronic exposure to irritant soils. It results in leg swelling, commonly complicated by acute dermatolymphangioadenitis (ADLA), characterised by severe pain, fever and disability. We conducted cost-effectiveness and social outcome analyses of a pragmatic, randomised controlled trial of a hygiene and foot-care intervention for people with podoconiosis in the East Gojjam zone of northern Ethiopia. Participants were allocated to the immediate intervention group or the delayed intervention group (control). The 12-month intervention included training in foot hygiene, skin care, bandaging, exercises, and use of socks and shoes, and was supported by lay community assistants. The cost-effectiveness analysis was conducted using the cost of productivity loss due to acute dermatolymphangioadenitis. Household costs were not included. Health outcomes in the cost-effectiveness analysis were: the incidence of ADLA episodes, health-related quality of life captured using the Dermatology Life Quality Index (DLQI), and disability scores measured using the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). The cost of the foot hygiene and lymphoedema management supplies was 529 ETB (69 I$, international dollars) per person per year. The cost of delivery of the intervention as part of the trial, including transportation, storage, training of lay community assistants and administering the intervention was 1,890 ETB (246 I$) per person. The intervention was effective in reducing the incidence of acute dermatolymphangioadenitis episodes and improving DLQI scores, while there were no significant improvements in the disability scores measured using WHODAS 2.0. In 75% of estimations, the intervention was less costly than the control. This was due to improved work productivity. Subgroup analyses based on income group showed that the intervention was cost-effective (both less costly and more effective) in reducing the number of acute dermatolymphangioadenitis episodes and improving health-related quality of life in families with monthly income <1,000 ETB (130 I$). For the subgroup with family income ≥1,000 ETB, the intervention was more effective but more costly than the control. Whilst there is evident benefit of the intervention for all, the economic impact would be greatest for the poorest.
Sections du résumé
BACKGROUND
Podoconiosis is a disease of the lymphatic vessels of the lower extremities that is caused by chronic exposure to irritant soils. It results in leg swelling, commonly complicated by acute dermatolymphangioadenitis (ADLA), characterised by severe pain, fever and disability.
METHODS
We conducted cost-effectiveness and social outcome analyses of a pragmatic, randomised controlled trial of a hygiene and foot-care intervention for people with podoconiosis in the East Gojjam zone of northern Ethiopia. Participants were allocated to the immediate intervention group or the delayed intervention group (control). The 12-month intervention included training in foot hygiene, skin care, bandaging, exercises, and use of socks and shoes, and was supported by lay community assistants. The cost-effectiveness analysis was conducted using the cost of productivity loss due to acute dermatolymphangioadenitis. Household costs were not included. Health outcomes in the cost-effectiveness analysis were: the incidence of ADLA episodes, health-related quality of life captured using the Dermatology Life Quality Index (DLQI), and disability scores measured using the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0).
RESULTS
The cost of the foot hygiene and lymphoedema management supplies was 529 ETB (69 I$, international dollars) per person per year. The cost of delivery of the intervention as part of the trial, including transportation, storage, training of lay community assistants and administering the intervention was 1,890 ETB (246 I$) per person. The intervention was effective in reducing the incidence of acute dermatolymphangioadenitis episodes and improving DLQI scores, while there were no significant improvements in the disability scores measured using WHODAS 2.0. In 75% of estimations, the intervention was less costly than the control. This was due to improved work productivity. Subgroup analyses based on income group showed that the intervention was cost-effective (both less costly and more effective) in reducing the number of acute dermatolymphangioadenitis episodes and improving health-related quality of life in families with monthly income <1,000 ETB (130 I$). For the subgroup with family income ≥1,000 ETB, the intervention was more effective but more costly than the control.
CONCLUSIONS
Whilst there is evident benefit of the intervention for all, the economic impact would be greatest for the poorest.
Identifiants
pubmed: 31644556
doi: 10.1371/journal.pntd.0007780
pii: PNTD-D-19-00570
pmc: PMC6808421
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0007780Subventions
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/K007211/1
Pays : United Kingdom
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Ann Trop Med Parasitol. 2008 Sep;102(6):529-40
pubmed: 18782492
Trop Med Int Health. 2006 Jul;11(7):1136-44
pubmed: 16827714
Trans R Soc Trop Med Hyg. 2010 Jan;104(1):42-7
pubmed: 19717176
Am J Trop Med Hyg. 2016 Oct 5;95(4):877-884
pubmed: 27573626
PLoS Negl Trop Dis. 2018 Mar 1;12(3):e0006324
pubmed: 29494642
Trans R Soc Trop Med Hyg. 2008 May;102(5):439-44
pubmed: 18339411
Int J Occup Saf Ergon. 2017 Mar;23(1):33-43
pubmed: 27277519
PLoS Negl Trop Dis. 2010 Nov 30;4(11):e902
pubmed: 21152059
Trans R Soc Trop Med Hyg. 1976;70(4):288-95
pubmed: 1006757
Lancet Glob Health. 2018 Jul;6(7):e795-e803
pubmed: 29773516
Parasit Vectors. 2018 Feb 1;11(1):75
pubmed: 29391042
Filaria J. 2003 Jan 24;2(1):1
pubmed: 12605723
Br J Dermatol. 2008 Sep;159(4):903-6
pubmed: 18671781
PLoS Negl Trop Dis. 2014 Sep 11;8(9):e3140
pubmed: 25211334
PLoS Negl Trop Dis. 2013;7(3):e2100
pubmed: 23516648
PLoS Negl Trop Dis. 2009 May 26;3(5):e424
pubmed: 19479039
Trials. 2015 Jul 16;16:307
pubmed: 26177812
PLoS Negl Trop Dis. 2016 Mar 11;10(3):e0004531
pubmed: 26967654
Stat Methods Med Res. 1999 Mar;8(1):3-15
pubmed: 10347857
BMC Med Res Methodol. 2018 Mar 7;18(1):26
pubmed: 29514613
Health Qual Life Outcomes. 2017 Apr 5;15(1):64
pubmed: 28381230
Int Health. 2011 Sep;3(3):176-81
pubmed: 24038367