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Contrasting benefits of different artemisinin combination therapies as first-line malaria treatments using model-based cost-effectiveness analysis

Title: Contrasting benefits of different artemisinin combination therapies as first-line malaria treatments using model-based cost-effectiveness analysis
Authors: Okell, LC
Cairns, M
Griffin, JT
Ferguson, NM
Tarning, J
Jagoe, G
Hugo, P
Baker, M
D'Alessandro, U
Bousema, T
Ubben, D
Ghani, AC
Item Type: Journal Article
Abstract: There are currently several recommended drug regimens for uncomplicated falciparum malaria in Africa. Each has different properties that determine its impact on disease burden. Two major antimalarial policy options are artemether–lumefantrine (AL) and dihydroartemisinin–piperaquine (DHA–PQP). Clinical trial data show that DHA–PQP provides longer protection against reinfection, while AL is better at reducing patient infectiousness. Here we incorporate pharmacokinetic-pharmacodynamic factors, transmission-reducing effects and cost into a mathematical model and simulate malaria transmission and treatment in Africa, using geographically explicit data on transmission intensity and seasonality, population density, treatment access and outpatient costs. DHA–PQP has a modestly higher estimated impact than AL in 64% of the population at risk. Given current higher cost estimates for DHA–PQP, there is a slightly greater cost per case averted, except in areas with high, seasonally varying transmission where the impact is particularly large. We find that a locally optimized treatment policy can be highly cost effective for reducing clinical malaria burden.
Issue Date: 1-Nov-2014
Date of Acceptance: 20-Oct-2014
URI: http://hdl.handle.net/10044/1/30719
DOI: 10.1038/ncomms6606
ISSN: 2041-1723
Publisher: Nature Publishing Group
Journal / Book Title: Nature Communications
Volume: 5
Issue: 1
Copyright Statement: This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/
Sponsor/Funder: Medical Research Council (MRC)
Medical Research Council (MRC)
Medical Research Council (MRC)
Funder's Grant Number: G1002387
MR/K010174/1B
G1002284
Keywords: Science & Technology
Multidisciplinary Sciences
Science & Technology - Other Topics
UNCOMPLICATED PLASMODIUM-FALCIPARUM
ARTEMETHER-LUMEFANTRINE
DIHYDROARTEMISININ-PIPERAQUINE
POPULATION PHARMACOKINETICS
AFRICAN CHILDREN
IN-VITRO
TRANSMISSION
PHARMACODYNAMICS
BENFLUMETOL
EVOLUTION
Africa
Antimalarials
Artemisinins
Cost-Benefit Analysis
Ethanolamines
Fluorenes
Humans
Lumefantrine
Malaria, Falciparum
Models, Theoretical
Quinolines
Seasons
Humans
Malaria, Falciparum
Ethanolamines
Artemisinins
Quinolines
Fluorenes
Antimalarials
Seasons
Models, Theoretical
Cost-Benefit Analysis
Africa
Lumefantrine
Science & Technology
Multidisciplinary Sciences
Science & Technology - Other Topics
PLASMODIUM-FALCIPARUM MALARIA
ARTEMETHER-LUMEFANTRINE
DIHYDROARTEMISININ-PIPERAQUINE
POPULATION PHARMACOKINETICS
UNCOMPLICATED MALARIA
AFRICAN CHILDREN
RANDOMIZED-TRIALS
TRANSMISSION
CAMBODIA
PHARMACODYNAMICS
Publication Status: Published
Article Number: 5606
Appears in Collections:Department of Infectious Diseases
Faculty of Medicine
School of Public Health