Introduction Pregnancy-associated malaria (PAM) is a health problem with serious clinical, epidemiological and economic effects. Purpose To analyze the microeconomic evaluations of PAM reported in the world scientific literature. Methods Systematic review with 15 different search strategies in PubMed, ScienceDirect, Scielo, Google Scholar and Malaria in Pregnancy (MiP) Library. A search, selection and extraction protocol was applied, which guaranteed completeness and reproducibility in accordance with preferred reporting items for systematic reviews and meta-analysis guidelines. The methodological quality was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guide. The analysis were based on frequencies, costs and average and incremental cost-effectiveness ratios in 2018 US dollars adjusted for purchasing power parity. Results Twenty-two evaluations published between 1990 and 2018 were analyzed, of which 82% addressed cost-effectiveness in Africa. Twelve interventions were studied; of these, intermittent preventive treatment in pregnant women with sulfadoxine-pyrimethamine (IPTp-SP) was the most frequent strategy. The main outcomes were low birth weight, anaemia and DALYs avoided. The best average cost-effectiveness ratio was reported in IPTp-SP with a cost of US$ 2 per DALY avoided, followed by the administration of IPTp-SP in pregnant women with HIV (US$ 14.2). Conclusions The studies focus on Africa with a high heterogeneity in the interventions, outcomes, resources and populations studied. All the interventions were highly cost-effective, which demonstrates the importance of including prevention, care and control resources for PAM as a priority in health sector budgets. This is especially true considering the importance of its intervention for social progress and overcoming poverty in endemic areas.
Background Gestational malaria is associated with negative outcomes in maternal and gestational health; timely diagnosis is crucial to avoid complications. However, the limited infrastructure, equipment, test reagents, and trained staff make it difficult to use thick blood smear tests in rural areas, where rapid testing could be a viable alternative. The purpose of this study was to estimate the cost-effectiveness of rapid tests type III (Plasmodium falciparum/Plasmodium spp P.f/pan) versus microscopic tests for the diagnosis and treatment of gestational malaria in Colombia. Methods Cost-effectiveness analyses of gestational malaria diagnosis from an institutional perspective using a decision tree. Standard costing was performed for the identification, measurement and assessment phases, with data from Colombian tariff manuals. The data was collected from Health Situation Analysis, SIVIGILA and meta-analysis. Average and incremental cost-effectiveness ratio were estimated. The uncertainty was assessed through probabilistic sensitivity analysis. Results The cost of rapid diagnostic tests in 3,000 pregnant women with malaria was US$66,936 and 1,182 disability adjusted life years (DALYs) were estimated. The cost using thick blood smear tests was US$50,838 and 1,023 DALYs, for an incremental cost-effectiveness of US$ 101.2. The probabilistic sensitivity analysis of rapid diagnostic tests determined that they are highly cost-effective in 70% of the cases, even below the US$1,200 threshold; also, they showed an incremental net monetary benefit of $150,000 when payer’s willingness is US$1,000. Conclusion The use of rapid diagnostic tests for timely diagnosis and treatment of gestational malaria is a highly cost-effective strategy in Colombia, with uncertainty analyses supporting the robustness of this conclusion and the increased net monetary benefit that the health system would obtain. This strategy may help in preventing the negative effects on maternal health and the neonate at a low cost.
Introducción: Existen diversas pruebas para el diagnóstico de las geohelmintiasis, con múltiples estudios que demuestran la heterogeneidad en su validez diagnóstica y pocos que aluden su costo-efectividad.Objetivo: Sistematizar las evaluaciones económicas sobre las pruebas aplicadas en el diagnóstico de geohelmintos.Métodos: Revisión sistemática en seis bases de datos con 24 estrategias de búsqueda. Se aplicó un protocolo de selección de estudios, garantizando exhaustividad, reproducibilidad y evaluación de la calidad metodológica. Se realizó síntesis cualitativa de la información.Resultados: En la literatura científica mundial sólo se dispone de cuatro evaluaciones económicas completas para el diagnóstico de geo-helmintos, en la modalidad de estudios de costo-efectividad; en éstas se evaluaron cinco pruebas en 247 adultos y 6.708 niños. En los desenlaces en salud empleados se encontraron la proporción de pacientes positivos y algunos parámetros de validez diagnóstica como la sensibilidad y la especificidad, mientras que los costos se circunscribieron a insumos y salarios. Estos hallazgos ponen de manifiesto la baja aplicación de los recursos teóricos y metodológicos de la economía de la salud en el diagnóstico de las geohelmintiasis.Conclusión: Las evaluaciones económicas de pruebas para el diagnóstico de geohelmintos y parásitos intestinales en general son exiguas en el ámbito mundial y los pocos estudios disponibles presentan limitaciones de validez interna y externa que impiden la aplicación de sus resultados a otros ámbitos.
An amendment to this paper has been published and can be accessed via the original article.
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