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Economic Evaluation of an Alternative Drug to Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment of Malaria in Pregnancy

Title: Economic Evaluation of an Alternative Drug to Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment of Malaria in Pregnancy
Authors: Sicuri, E
Fernandes, S
Macete, E
González, R
Mombo-Ngoma, G
Massougbodgi, A
Abdulla, S
Kuwawenaruwa, A
Katana, A
Desai, M
Cot, M
Ramharter, M
Kremsner, P
Slustker, L
Aponte, J
Hanson, K
Menéndez, C
Item Type: Journal Article
Abstract: BACKGROUND: Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended in HIV-negative women to avert malaria, while this relies on cotrimoxazole prophylaxis (CTXp) in HIV-positive women. Alternative antimalarials are required in areas where parasite resistance to antifolate drugs is high. The cost-effectiveness of IPTp with alternative drugs is needed to inform policy. METHODS: The cost-effectiveness of 2-dose IPTp-mefloquine (MQ) was compared with IPTp-SP in HIV-negative women (Benin, Gabon, Mozambique and Tanzania). In HIV-positive women the cost-effectiveness of 3-dose IPTp-MQ added to CTXp was compared with CTXp alone (Kenya, Mozambique and Tanzania). The outcomes used were maternal clinical malaria, anaemia at delivery and non-obstetric hospital admissions. The poor tolerability to MQ was included as the value of women's loss of working days. Incremental cost-effectiveness ratios (ICERs) were calculated and threshold analysis undertaken. RESULTS: For HIV-negative women, the ICER for IPTp-MQ versus IPTp-SP was 136.30 US$ (2012 US$) (95%CI 131.41; 141.18) per disability-adjusted life-year (DALY) averted, or 237.78 US$ (95%CI 230.99; 244.57), depending on whether estimates from Gabon were included or not. For HIV-positive women, the ICER per DALY averted for IPTp-MQ added to CTXp, versus CTXp alone was 6.96 US$ (95%CI 4.22; 9.70). In HIV-negative women, moderate shifts of variables such as malaria incidence, drug cost, and IPTp efficacy increased the ICERs above the cost-effectiveness threshold. In HIV-positive women the intervention remained cost-effective for a substantial (up to 21 times) increase in cost per tablet. CONCLUSIONS: Addition of IPTp with an effective antimalarial to CTXp was very cost-effective in HIV-positive women. IPTp with an efficacious antimalarial was more cost-effective than IPTp-SP in HIV-negative women. However, the poor tolerability of MQ does not favour its use as IPTp. Regardless of HIV status, prevention of malaria in pregnancy with a highly efficacious, well tolerated antimalarial would be cost-effective despite its high price. TRIALS REGISTRATION: ClinicalTrials.gov NCT 00811421; Pan African Trials Registry PACTR2010020001429343 and PACTR2010020001813440.
Issue Date: 27-Apr-2015
Date of Acceptance: 15-Mar-2015
URI: http://hdl.handle.net/10044/1/41133
DOI: http://dx.doi.org/10.1371/journal.pone.0125072
ISSN: 1932-6203
Publisher: Public Library of Science
Journal / Book Title: PLOS One
Volume: 10
Issue: 4
Copyright Statement: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
Keywords: Antimalarials
Cost-Benefit Analysis
Drug Combinations
Female
HIV Infections
Humans
Kenya
Malaria
Mefloquine
Mozambique
Pregnancy
Pregnancy Complications, Parasitic
Pyrimethamine
Sulfadoxine
Tanzania
Treatment Outcome
Humans
HIV Infections
Pregnancy Complications, Parasitic
Malaria
Sulfadoxine
Pyrimethamine
Mefloquine
Drug Combinations
Antimalarials
Treatment Outcome
Pregnancy
Cost-Benefit Analysis
Kenya
Tanzania
Mozambique
Female
General Science & Technology
MD Multidisciplinary
Publication Status: Published
Article Number: e0125072
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



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