Anthropometrically derived dosing and drug costing calculations for treating visceral leishmaniasis in Bihar, India

To estimate drug costs of treating visceral leishmaniasis (VL) based on data on the VL population structure from the high-burden, antimony-resistant area of Northern Bihar, India. Paromomycin is the cheapest option ($7450 to treat 1000 patients). Treating 1000 patients with oral miltefosine would cost $119 250 at the current private market price or $64 383-$75 129 at preferential public sector price depending on the size of the order. With AmBisome® it would be $163 600 or $229 500 depending on the dose (10 or 15 mg/kg total). These costs are without considering other direct costs (daily intramuscular injections for 3 weeks for paromomycin; intravenous devices and hospitalization for AmBisome®; directly observed treatment if applied for miltefosine) and indirect costs. These calculations provide useful basic information for projections.