Cost effectiveness of intermittent screening followed by treatment versus intermittent preventive treatment during pregnancy in West Africa: analysis and modelling of results from a non-inferiority trial

Malaria Journal

Research

Sory Ibrahim Diawara¹  Diawara Halimatou¹  Kassoum Kayentao²  Sheikh Coulibaly³  Elisa Sicuri⁴  Pascal Magnussen⁵  Feiko ter Kuile⁶  Silke Fernandes⁷  Daniel Chandramohan⁷  Brian Greenwood⁷  Kara Hanson⁷  Matthew Cairns⁷  Arouna Woukeu⁷  Kalifa Boiang⁸  John Williams⁹  James Akazili⁹  Harry Tagbor^1,10 

[1] Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Dentistry, Malaria Research and Training Centre, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali;Department of Epidemiology of Parasitic Diseases, Faculty of Medicine, Pharmacy and Dentistry, Malaria Research and Training Centre, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali;Liverpool School of Tropical Medicine, Liverpool, UK;Faculty of Health Sciences, University of Ouagadougou, Ouagadougou, Burkina Faso;ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain;Institute of International Health, Immunology and Microbiology, Centre for Medical Parasitology and Institute of Veterinary Disease Biology, University of Copenhagen, Copenhagen, Denmark;Liverpool School of Tropical Medicine, Liverpool, UK;London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK;Medical Research Council Unit, Fajara, Gambia;Navrongo Health Research Centre, Navrongo, Ghana;School of Medicine, University of Health and Allied Sciences, Ho, Ghana;

关键词: Malaria;    Rapid Diagnostic Test;    Clinical Malaria;    Placental Malaria;    Disability Weight;   

DOI  :  10.1186/s12936-016-1539-4

 received in 2016-05-05, accepted in 2016-09-14,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundEmergence of high-grade sulfadoxine-pyrimethamine (SP) resistance in parts of Africa has led to growing concerns about the efficacy of intermittent preventive treatment of malaria during pregnancy (IPTp) with SP. The incremental cost-effectiveness of intermittent screening and treatment (ISTp) with artemether-lumefantrine (AL) as an alternative strategy to IPTp-SP was estimated followed by a simulation of the effects on cost-effectiveness of decreasing efficacy of IPTp-SP due to SP resistance. The analysis was based on results from a multi-centre, non-inferiority trial conducted in West Africa.MethodsA decision tree model was analysed from a health provider perspective. Model parameters for all trial countries with appropriate ranges and distributions were used in a probabilistic sensitivity analysis. Simulations were performed in hypothetical cohorts of 1000 pregnant women who received either ISTp-AL or IPTp-SP. In addition a cost-consequences analysis was conducted. Trial estimates were used to calculate disability-adjusted-life-years (DALYs) for low birth weight and severe/moderate anaemia (both shown to be non-inferior for ISTp-AL) and clinical malaria (inferior for ISTp-AL). Cost estimates were obtained from observational studies, health facility costings and public procurement databases. Results were calculated as incremental cost per DALY averted. Finally, the cost-effectiveness changes with decreasing SP efficacy were explored by simulation.ResultsRelative to IPTp-SP, delivering ISTp-AL to 1000 pregnant women cost US$ 4966.25 more (95 % CI US$ 3703.53; 6376.83) and led to a small excess of 28.36 DALYs (95 % CI −75.78; 134.18), with LBW contributing 81.3 % of this difference. The incremental cost-effectiveness ratio was −175.12 (95 % CI −1166.29; 1267.71) US$/DALY averted. Simulations show that cost-effectiveness of ISTp-AL increases as the efficacy of IPTp-SP decreases, though the specific threshold at which ISTp-AL becomes cost-effective depends on assumptions about the contribution of bed nets to malaria control, bed net coverage and the willingness-to-pay threshold used.ConclusionsAt SP efficacy levels currently observed in the trial settings it would not be cost-effective to switch from IPTp-SP to ISTp-AL, mainly due to the substantially higher costs of ISTp-AL and limited difference in outcomes. The modelling results indicate thresholds below which IPT-SP efficacy must fall for ISTp-AL to become a cost-effective option for the prevention of malaria in pregnancy.

【 授权许可】

CC BY   
© The Author(s) 2016