Epidemiology and Infection

The cost-effectiveness of ivermectin vs. albendazole in the presumptive treatment of strongyloidiasis in immigrants to the United States

P. MUENNIG a1c1, D. PALLIN a2, C. CHALLAH a3 and K. KHAN a4
a1 Department of Health Policy and Management, Mailman School of Public Health, Columbia University, NY, USA
a2 Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, MA, USA
a3 Department of Community Health and Social Medicine, CUNY Medical School, NY, USA
a4 Inner City Health Research Unit, St. Michael's Hospital, University of Toronto, Canada

Article author query
muennig p   [PubMed][Google Scholar] 
pallin d   [PubMed][Google Scholar] 
challah c   [PubMed][Google Scholar] 
khan k   [PubMed][Google Scholar] 


The presumptive treatment of parasitosis among immigrants with albendazole has been shown to save both money and lives, primarily via a reduction in the burden of Strongyloides stercoralis. Ivermectin is more effective than albendazole, but is also more expensive. This coupled with confusion surrounding the cost-effectiveness of guiding therapy based on eosinophil counts has led to disparate practices. We used the newly arrived year 2000 immigrant population as a hypothetical cohort in a decision analysis model to examine the cost-effectiveness of various interventions to reduce parasitosis among immigrants. When the prevalence of S. stercoralis is greater than 2%, the incremental cost-effectiveness ratios of all presumptive treatment strategies were similar. Ivermectin is associated with an incremental cost-effectiveness ratio of $1700 per QALY gained for treatment with 12 mg ivermectin relative to 5 days of albendazole when the prevalence is 10%. Any presumptive treatment strategy is cost-effective when compared with most common medical interventions.

(Accepted July 19 2004)

c1 Dr P. A. Muennig, Assistant Professor, Mailman School of Public Health, Columbia University, 600 W. 168th St., 6th Floor, New York, NY 10032, USA. (Email: pm124@columbia.edu)