Cost-effectiveness of parenteral artesunate for treating children with severe malaria in sub-Saharan Africa

Lubell, Yoel; Riewpaiboon, Arthorn; Dondorp, Arjen M.; Seidlein, Lorenz von; Mokuolu, Olugbenga A.; Nansumba, Margaret; Gesase, Samwel; Kent, Alison; Mtove, George; Olaosebikan, Rasaq; Pan-ngum, Wirichada; Fanello, Caterina; Hendriksen, Ilse C. E.; Day, Nicholas P. J.; White, Nicholas J.; Yeung, Shunmay

doi:10.2471/blt.11.085878

Cited by 47 publications

(51 citation statements)

References 14 publications

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“…Subsequent cost-effectiveness analyses confirmed the economic superiority of artesunate over quinine in the management of malaria in both the African [6] and Asian [7] settings, with an incremental cost per death averted of approximately $150 in both settings, and is therefore highly cost-effective.…”

Section: Introductionmentioning

confidence: 94%

Cost of treating inpatient falciparum malaria on the Thai-Myanmar border

Kyaw

Drake

Ruangveerayuth

et al. 2014

Malar J

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BackgroundDespite demonstrated benefits and World Health Organization (WHO) endorsement, parenteral artesunate is the recommended treatment for patients with severe Plasmodium falciparum malaria in only one fifth of endemic countries. One possible reason for this slow uptake is that a treatment course of parenteral artesunate is costlier than quinine and might, therefore, pose a substantial economic burden to health care systems. This analysis presents a detailed account of the resources used in treating falciparum malaria by either parenteral artesunate or quinine in a hospital on the Thai-Myanmar border.MethodsThe analysis used data from four studies, with random allocation of inpatients with falciparum malaria to treatment with parenteral artesunate or quinine, conducted in Mae Sot Hospital, Thailand from 1995 to 2001. Detailed resource use data were collected during admission and unit costs from the 2008 hospital price list were applied to these. Total admission costs were broken down into five categories: 1) medication; 2) intravenous fluids; 3) disposables; 4) laboratory tests; and 5) services.ResultsWhile the medication costs were higher for patients treated with artesunate, total admission costs were similar in those treated with quinine, US$ 243 (95% CI: 167.5-349.7) and in those treated with artesunate US$ 190 (95% CI: 131.0-263.2) (P = 0.375). For cases classified as severe malaria (59%), the total cost of admission was US$ 298 (95% CI: 203.6-438.7) in the quinine group as compared with US$ 284 (95% CI: 181.3-407) in the artesunate group (P = 0.869).ConclusionThis analysis finds no evidence for a difference in total admission costs for malaria inpatients treated with artesunate as compared with quinine. Assuming this is generalizable to other settings, the higher cost of a course of artesunate should not be considered a barrier for its implementation in the treatment of malaria.

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Section: Introductionmentioning

confidence: 94%

Cost of treating inpatient falciparum malaria on the Thai-Myanmar border

Kyaw

Drake

Ruangveerayuth

et al. 2014

Malar J

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“…It needs to be noted that the WHO has changed their guidelines for the treatment of severe malaria to artesunate for all age groups in all endemic settings, based on recently published studies [43,102].…”

Section: Resultsmentioning

confidence: 99%

“…These excluded costs can reduce the cost-effectiveness of artesunate, but the costs per death averted demonstrate that it remains a highly attractive intervention [17]. Further evidence has been provided on the cost-effectiveness of artesunate [43].…”

Section: Severe Malariamentioning

confidence: 99%

Malaria Treatment and Prophylaxis in Endemic and Nonendemic Countries: Evidence on Strategies and Their Cost–Effectiveness

et al. 2011

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Artemisinin combination treatment is currently the preferred treatment strategy to combat malaria. However, the drug costs are considerably higher than for previously used therapies. This review discusses the cost-effectiveness of current malaria treatment and prophylaxis in endemic and nonendemic countries. For endemic countries, a systematic search for economic evaluations (i.e., cost-effectiveness, cost-utility and cost-benefit analyses) was conducted, looking at the use of Artemisinin combination treatments in children, pregnant women and other adults. In total, 24 studies were identified investigating the cost-effectiveness of malaria treatments with the focus on uncomplicated malaria, severe or prereferral treatment, all in combination with adequate diagnosis, and malaria prevention by intermittent preventive treatment, respectively. In areas with both Plasmodium falciparum and Plasmodium vivax transmission, artemether-lumefantrine and dihydroartemisinin-piperaquine, respectively, are currently the most cost-effective treatment options. Treatment of severe malaria with artesunate is more cost effective compared with treatment with quinine. For patients that live more than 6 h away from an appropriate healthcare facility, prereferral treatment proved to be more cost-effective compared with no prereferral intervention. Cost-effectiveness of intermittent preventive treatment in pregnant women (IPTp) was dependent an clinical attendance. IPT in infants with sulphadoxine-pyrimethamine (SP) is cost effective in sites with high malaria transmission. IPT in children with artesunate (AS + SP), amodiaquine (AQ) + SPQ or SP alone is a cost effective and safe intervention for reducing the burden of malaria in children in areas with markedly seasonal malaria transmission. Although there is a need for it, little is known about the cost-effectiveness of current approaches to malaria therapy in nonendemic countries and the cost-effectiveness of antimalarial chemoprophylaxis.

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“…Published estimates were used for the probability of developing severe malaria after failing first-line oral treatment, 15 the case fatality rate for severe malaria after inpatient treatment, and the proportion of severe malaria survivors with persisting neurological sequelae in African settings 16 (Table 1). We estimated the mean difference in costs (incremental costs) and the mean difference in health outcomes (incremental health outcomes) of the two treatment strategies per patient over a 1-year period.…”

Section: Methodsmentioning

confidence: 99%

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

Pfeil

Borrmann

Bassat

et al. 2015

The American Journal of Tropical Medicine and Hygiene

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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.

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Cost-effectiveness of parenteral artesunate for treating children with severe malaria in sub-Saharan Africa

Cited by 47 publications

References 14 publications

Cost of treating inpatient falciparum malaria on the Thai-Myanmar border

Cost of treating inpatient falciparum malaria on the Thai-Myanmar border

Malaria Treatment and Prophylaxis in Endemic and Nonendemic Countries: Evidence on Strategies and Their Cost–Effectiveness

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

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