Cost Effectiveness of Seasonal Intermittent Preventive Treatment Using Amodiaquine & Artesunate or Sulphadoxine-Pyrimethamine in Ghanaian Children

Abstract

BackgroundIntermittent preventive treatment for malaria in children (IPTc) involves the administration of a full course of an anti-malarial treatment to children under 5 years old at specified time points regardless of whether or not they are known to be infected, in areas where malaria transmission is seasonal. It is important to determine the costs associated with IPTc delivery via community based volunteers and also the potential savings to health care providers and caretakers due to malaria episodes averted as a consequence of IPTc.MethodsTwo thousand four hundred and fifty-one children aged 3–59 months were randomly allocated to four groups to receive: three days of artesunate plus amodiaquine (AS+AQ) monthly, three days of AS+AQ bimonthly, one dose of sulphadoxine-pyrimethamine (SP) bi-monthly or placebo. This paper focuses on incremental cost effectiveness ratios (ICERs) of the three IPTc drug regimens as delivered by community based volunteers (CBV) in Hohoe, Ghana compared to current practice, i.e. case management in the absence of IPTc. Financial and economic costs from the publicly funded health system perspective are presented. Treatment costs borne by patients and their caretakers are also estimated to present societal costs. The costs and effects of IPTc during the intervention period were considered with and without a one year follow up. Probabilistic sensitivity analysis was undertaken to account for uncertainty.ResultsEconomic costs per child receiving at least the first dose of each course of IPTc show SP bimonthly, at US$8.19, is the cheapest to deliver, followed by AS+AQ bimonthly at US$10.67 and then by AS+AQ monthly at US$14.79. Training, drug delivery and supervision accounted for approximately 20–30% each of total unit costs. During the intervention period AS & AQ monthly was the most cost effective IPTc drug regimen at US$67.77 (61.71–74.75, CI 95%) per malaria case averted based on intervention costs only, US$64.93 (58.92–71.92, CI 95%) per malaria case averted once the provider cost savings are included and US$61.00 (54.98, 67.99, CI 95%) when direct household cost savings are also taken into account. SP bimonthly was US$105.35 (75.01–157.31, CI 95%) and AS & AQ bimonthly US$211.80 (127.05–399.14, CI 95%) per malaria case averted based on intervention costs only. The incidence of malaria in the post intervention period was higher in children who were <1 year old when they received AS+AQ monthly compared to the placebo group leading to higher cost effectiveness ratios when one year follow up is included. The cost per child enrolled fell considerably when modelled to district level as compared to those encountered under trial conditions.ConclusionsWe demonstrate how cost-effective IPTc is using three different drug regimens and the possibilities for reducing costs further if the intervention was to be scaled up to the district level. The need for effective training, drug delivery channels and supervision to support a strong network of community based volunteers is emphasised.

Isolation and characterization of Pseudomonas sp. DX7 capable of degrading sulfadoxine

“…malaria (Mulenga et al 1999;Van Dillen et al 1999;Kofoed et al 2006;Kolaczinski et al 2007;Obonyo et al 2007;Conteh et al 2010;Aziken et al 2011). Sulfadoxine provides a bacteriostatic effect by inhibiting the production of folic acid, which is required for bacterial growth (Craig and Stitzel 1994).…”

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

“…It has been shown that after discontinuation of IPT, clinical episodes did not increase in most settings; in addition, presumptive treatment did not show a significant rebound effect in terms of an increase of clinical malaria episodes after discontinuation of treatment [22]. Previous studies showed that IPT is an effective strategy in the fight against malaria, especially in areas with seasonal transmission of malaria [23]. IPT has been endorsed by the WHO as a potential intervention to reduce malaria morbidity and mortality in pregnant women (IPTp) and infants (IPTi).…”

“…Temperley et al 2008 17 [45] Mbonye et al 2008 18 [44] Hutton et al 2009 16 [22] Conteh et al 2010 17 [21] Conteh et al 2010 17 [23] Sicuri et al 2010 13 [31] CHEC: Consensus Health Economic Criteria. which could lead to misdiagnosis [7].…”

“…Studies in Senegal and Mali have shown that IPTc with AS + SP, AQ + SPQ or SP alone is an efficacious and safe intervention for reducing the burden of malaria in children in areas with high transmission with short transmission periods [47,48]. Another study conducted in Ghana explored the effects of IPTc in areas with a more prolonged transmission season, such as in Ghana [23]. When analyzing the cost-effectiveness of IPTc for AS + AQ or SP, provider and direct household costs were included.…”

“…Training, drug delivery and supervision accounted for approximately 20-30% each of total unit costs. The most significant difference in the economic and financial costs appeared in the training cost centers [23]. Nonendemic countries: "drug" prevention strategies and their cost-effectiveness…”