Costs Associated with Malaria in Pregnancy in the Brazilian Amazon, a Low Endemic Area Where Plasmodium vivax Predominates

Abstract

BackgroundInformation on costs associated with malaria in pregnancy (MiP) in low transmission areas where Plasmodium vivax predominates is so far missing. This study estimates health system and patient costs of MiP in the Brazilian Amazon.Methods/Principal FindingsBetween January 2011 and March 2012 patient costs for the treatment of MiP were collected through an exit survey at a tertiary referral hospital and at a primary health care centre in the Manaus metropolitan area, Amazonas state. Pregnant and post-partum women diagnosed with malaria were interviewed after an outpatient consultation or at discharge after admission. Seventy-three interviews were included in the analysis. Ninety-six percent of episodes were due to P. vivax and 4% to Plasmodium falciparum. In 2010, the total median costs from the patient perspective were estimated at US $45.91 and US $216.29 for an outpatient consultation and an admission, respectively. When multiple P. vivax infections during the same pregnancy were considered, patient costs increased up to US $335.85, representing the costs of an admission plus an outpatient consultation. Provider direct and overhead cost data were obtained from several sources. The provider cost associated with an outpatient case, which includes several consultations at the tertiary hospital was US $103.51 for a P. vivax malaria episode and US $83.59 for a P. falciparum malaria episode. The cost of an inpatient day and average admission of 3 days was US $118.51 and US $355.53, respectively. Total provider costs for the diagnosis and treatment of all malaria cases reported in pregnant women in Manaus in 2010 (N = 364) were US $17,038.50, of which 92.4% (US$ 15,741.14) due to P. vivax infection.ConclusionDespite being an area of low risk malaria transmission, MiP is responsible for a significant economic burden in Manaus. Especially when multiple infections are considered, costs associated with P. vivax are higher than costs associated with P. falciparum. The information generated may help health policy decisions for the current control and future elimination of malaria in the area.

Economic costs analysis of uncomplicated malaria case management in the Peruvian Amazon

“…Indeed, the length of time lost due to illness in a patient, found to be associated with delayed confirmatory malaria diagnosis, was the parameter that caused most uncertainty in the average costs per malaria episode for both species. As in Colombia [38], Brazil [39] and other endemic areas outside the Americas [19,40,41], uncomplicated malaria episodes in Mazan imposes significant costs on households, pushing poor families further into poverty. In several Amazonian communities with high risk of malaria transmission, the situation can become catastrophic due to the occurrence of repeated episodes in the same individuals and/or the same households every year [11,38,39,42,43].…”

Household Costs Associated With Seeking Malaria Treatment During Pregnancy: Evidence From Burkina Faso and The Gambia

“…Indirect costs were collected for inpatient visits only. They were calculated by multiplying reported time lost by the nominal value of the median monthly permanent income per capita of households in Burkina Faso and The Gambia, represented by country speci c estimates by the International Labour Organisation [21,23,26]. We tested whether costs, both direct and indirect, for previous treatment sought were statistically different between Burkina Faso and The Gambia for both inpatients and outpatients.…”

“…Costing studies associated with MiP are largely in the form of economic evaluations reporting either the actual or projected costs and cost-effectiveness of preventive interventions such as IPTp and LLIN [14][15][16][17][18]. A few evaluate costs from the provider [14,17,19,20] and/or user perspectives [1,17,[20][21][22][23]. The aim of this study was to estimate the costs of malaria episodes incurred by pregnant women in Burkina Faso and The Gambia using primary, individual-level data collected after an outpatient consultation or at discharge after hospitalization.…”

Morfometria geométrica e banco de dados na investigação de problemas biológicos em Culicidae.

“…Esta doença é causada por cerca de seis espécies de Plasmódios [14] e transmitida por pelo menos 60 espécies de Anopheles [15]. Estes dados são sempre preocupantes, pois além de ser um problema à saúde das pessoas, estas doenças têm um alto custo econômico e clínico para a sociedade [16][17][18].…”