Cost-Effectiveness Analysis of Three Leprosy Case Detection Methods in Northern Nigeria

Background: Despite several leprosy control measures in Nigeria, child proportion and disability grade 2 cases remain high
while new cases have not significantly reduced, suggesting continuous spread of the disease. Hence, there is the need to
review detection methods to enhance identification of early cases for effective control and prevention of permanent
disability. This study evaluated the cost-effectiveness of three leprosy case detection methods in Northern Nigeria to
identify the most cost-effective approach for detection of leprosy.
Methods: A cross-sectional study was carried out to evaluate the additional benefits of using several case detection
methods in addition to routine practice in two north-eastern states of Nigeria. Primary and secondary data were collected
from routine practice records and the Nigerian Tuberculosis and Leprosy Control Programme of 2009. The methods
evaluated were Rapid Village Survey (RVS), Household Contact Examination (HCE) and Traditional Healers incentive method
(TH). Effectiveness was measured as number of new leprosy cases detected and cost-effectiveness was expressed as cost per
case detected. Costs were measured from both providers’ and patients’ perspectives. Additional costs and effects of each
method were estimated by comparing each method against routine practise and expressed as incremental costeffectiveness
ratio (ICER). All costs were converted to the U.S. dollar at the 2010 exchange rate. Univariate sensitivity analysis
was used to evaluate uncertainties around the ICER.
Results: The ICER for HCE was $142 per additional case detected at all contact levels and it was the most cost-effective
method. At ICER of $194 per additional case detected, THs method detected more cases at a lower cost than the RVS, which
was not cost-effective at $313 per additional case detected. Sensitivity analysis showed that varying the proportion of
shared costs and subsistent wage for valuing unpaid time did not significantly change the results.
Conclusion: Complementing routine practice with household contact examination is the most cost-effective approach to
identify new leprosy cases and we recommend that, depending on acceptability and feasibility, this intervention is
introduced for improved case detection in Northern Nigeria.