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

Abstract

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.

An operational comparative study of quinine and artesunate for the treatment of severe malaria in hospitals and health centres in the Democratic Republic of Congo: the MATIAS study

“…The estimated costs of treating a patient with severe malaria in this study are similar to those calculated in previous studies [ 15 , 16 ], although lower than those reported by Kyaw et al , which used a more detailed cost analysis approach [ 17 ]. The costs were highly variable, depending on the level and type of facility (public, private or missionary).…”

Economic burden of malaria inpatients during National Malaria Elimination Programme: estimation of hospitalization cost and its inter-province variation

“…It would be expected that in areas with high malaria burdens, the per inpatient cost would be lower as fixed costs are spread over a larger number of patients. Meanwhile, another evidence showed that the cost for hospitalization services in China was much higher than that in Thailand [ 28 ]. Besides, the hospitalization cost was almost twofold compared to that in a recent study in China (2587 RMB, which adjusted and converted to 409.14 USD according to the value of money in 2011) [ 10 ].…”

“…This type of information was directly obtained from the first page of medical records. Referring to one similar study [ 28 ], the direct medical cost in this study was classified into six categories: (1) Medications: including western medications and traditional Chinese medications, such as antibiotics and supportive treatment medications. Notably, anti-malarials were excluded from this category since they are free-of-charge and publicly available.…”

Costs and Cost-Effectiveness of Malaria Control Interventions: A Systematic Literature Review

“…Cost-effectiveness was analyzed in 5 studies. 88,89,92,95,96 Most studies were published after 2010 76,78,[80][81][82][83][84][85][86][87][88][89][90]94,96 and concerned uncomplicated malaria only, 78,80,[82][83][84]88,89,[91][92][93]95,96 both uncomplicated and severe malaria, 76,79,81,86,90,94 with severe or moderate anemia 81 or severe malaria only 77,85,87 in all ages, 78,80,82,83,89,91,93 infants/ children, 76,80,…”