An Economic Evaluation of the Posttreatment Prophylactic Effect of Dihydroartemisinin–Piperaquine Versus Artemether–Lumefantrine for First-Line Treatment of Plasmodium falciparum Malaria Across Different Transmission Settings in Africa

Abstract

Abstract. Malaria disproportionately affects young children. Clinical trials in African children showed that dihydroartemisininpiperaquine (DP) is an effective antimalarial and has a longer posttreatment prophylactic (PTP) effect against reinfections than other artemisinin-based combination therapies, including artemether-lumefantrine (AL). Using a previously developed Markov model and individual patient data from a multicenter African drug efficacy trial, we assessed the economic value of the PTP effect of DP versus AL in pediatric malaria patients from health-care provider's perspective in lowto-moderate and moderate-to-high transmission settings under different drug co-payment scenarios. In low-to-moderate transmission settings, first-line treatment with DP was highly cost-effective with an incremental cost-effectiveness ratio of US$5 (95% confidence interval [CI] = −76 to 196) per disability-adjusted life year (DALY) averted. In moderate-to-high transmission settings, DP first-line treatment led to a mean cost saving of US$1.09 (95% CI = −0.88 to 3.85) and averted 0.05 (95% CI = −0.08 to 0.22) DALYs per child per year. Our results suggested that DP might be superior to AL for first-line treatment of uncomplicated childhood malaria across a range of transmission settings in Africa.

Therapeutic efficacy of artemether-lumefantrine against uncomplicated Plasmodium falciparum malaria in a high-transmission area in northwest Ethiopia

“…falciparum malaria in an Italian tourist returned from Ethiopia [ 51 ]. Post-treatment prophylactic effect of DHA-PPQ against re-infections is considered longer than that of AL [ 52 ]. In Ethiopia DHA-PPQ failures have not been reported before.…”

Cost-effectiveness analysis of malaria interventions using disability adjusted life years: a systematic review

“…This intervention showed a cost of $5 per DALY averted. Three of the reviewed studies compared the cost-effectiveness of dihydroartemisinin–piperaquine (DP) and artemether–lumefantrine (AL) in treatment of complicated malaria [ 21 , 23 , 55 ]. The maximum cost per DALY averted for these three studies was $12.54.…”

“…It was predicted that DP was more cost-effective compared to AL with the assumption that compliance to treatment was higher in DP than in AL due to the once a day dose for DP [ 23 ]. It was also suggested that DP might be more cost effective than AL across a range of settings in Africa [ 55 ].…”

Dihydroartemisinin-piperaquine: if it works for control, can we use it for elimination?

“…[3][4][5] From a preventive point of view, the long half-life of the partner drug piperaquine conveys protection of 22 days for adult patients and around 20 days for paediatric patients, 2 indicating a better post-treatment prophylactic eff ect than other combination therapies. 3,6,7 In the Lancet Infectious Diseases, Julie Gutman and colleagues analyse the safety, tolerability, and effi cacy of repeated doses of DP, for the treatment and prevention of malaria, with a particular focus on its use as intermittent preventive treatment (IPT). 8 Their meta-analysis, looking at over 4000 patients exposed to repeated courses of DP, substantiates the high effi cacy of this drug in terms of controlling malaria and all-cause hospital admission, and the good tolerability of repeated treatment schemes, with no evidence of arrhythmias secondary to the potential QT prolongation eff ect of cumulative doses of piperaquine after repeated doses.…”