Does public subsidy of the cost of malaria chemoprophylaxis reduce imported malaria? A comparative policy analysis

Malaria Journal

Research

Steve Taylor¹  Penny E Neave²  Ron H Behrens³ 

[1] Department of Biostatistics, AUT University, Auckland, New Zealand;Department of Community Health Development, AUT University, Auckland, New Zealand;Hospital for Tropical Diseases, Mortimer Market, & London School of Hygiene and Tropical Medicine, London, UK;

关键词: Imported malaria;    Chemoprophylaxis;    Subsidized costs;    Evaluation;   

DOI  :  10.1186/1475-2875-12-238

 received in 2013-04-23, accepted in 2013-07-01,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundChemoprophylaxis is recommended for at-risk travellers visiting malaria endemic regions. The majority of travellers with imported malaria have not used this, and travellers visiting friends and relatives have the largest burden of malaria and the lowest compliance to chemoprophylaxis. In 1995, the UK’s Department of Health (DH) implemented a policy to make travellers fully responsible for the cost when purchasing chemoprophylaxis. This policy was not implemented in three Primary Care Trusts (PCTs) in London due to concern about the potential increase of imported malaria in their residents, and they maintained the public subsidy. An impact evaluation of the policy change was undertaken to determine if the continued subsidy reduced the incidence of imported malaria in one of the boroughs where the subsidy was maintained when compared to a borough where no subsidy was provided.MethodsBetween 2007 and 2010 prescriptions for malaria chemoprophylaxis were collected from pharmacy records and PCTs, and all cases of imported malaria reported from the tertiary hospital in each of the two boroughs were compared.ResultsThe dispensed chemoprophylaxis prescriptions were nearly 8.8 times higher in Lambeth (where subsidized drugs were provided), than in Hackney. A Poisson model revealed significantly fewer reports of imported malaria per capita were made in Lambeth compared to Hackney (p = 0.042).ConclusionsThe difference in malaria reports between the boroughs only just reached statistical significance, despite the considerable difference in chemoprophylaxis prescribing between the boroughs. Some travellers may not consider using chemoprophylaxis, irrespective of the cost. Regular evaluations of the recent policy changes in areas where malaria is subsidized will be important.

【 授权许可】

CC BY   
© Neave et al.; licensee BioMed Central Ltd. 2013