1
|
Hezagira N, Youngkong S, Riewpaiboon A. Cost-Utility Analysis of Community Case Management for Malaria Control in Burundi. Int J Health Policy Manag 2022; 11:2990-2999. [PMID: 35643419 PMCID: PMC10105195 DOI: 10.34172/ijhpm.2022.6290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/10/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The community case management (CCM) program for malaria control is a community-based strategy implemented to regulate malaria in children in Burundi. This study compared the cost and utility of implementing the CCM program combined with health facility management (HFM) versus HFM alone for malaria control in children under five in Burundi. METHODS This study constructed a five-year Markov model with one-week cycles to estimate cost-utility and budget impact analysis (BIA). The model defined 10 health states, simulating the progression of the disease and the risk of recurrent malaria in children under five years of age. Cost data were empirically collected and presented for 2019. Incremental cost per disability-adjusted life year (DALY) averted, and a five-year budget was estimated. One-way and probabilistic sensitivity analyses (PSAs) were then performed. RESULTS From provider and societal perspectives, combining the CCM program with HFM for malaria control in Burundi was more cost-effective than implementing HFM alone. The addition of CCM, using artesunate amodiaquine (ASAQ) as the first-line treatment, increased by US$1.70, and US$ 1.67 per DALY averted from the provider and societal perspectives, respectively. Using Artemether Lumefantrine (AL) as the first-line treatment, adding the CCM program to HFM increased by US$ 1.92, and US$ 1.87 per DALY averted from the provider and societal perspectives. At a willingness-to-pay of one GDP/capita, the CCM program remained a 100% chance of being cost-effective. In addition, implementing the program for five years requires a budget of US$ 15 800 486-19 765 117. CONCLUSION Implementing the CCM program and HFM is value for money for malaria control in Burundi. The findings can support decision-makers in Burundi in deciding on resource allocation, especially during the program's scale up.
Collapse
Affiliation(s)
- Nina Hezagira
- Social, Economic and Administrative Pharmacy Program, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Sitaporn Youngkong
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Arthorn Riewpaiboon
- Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| |
Collapse
|
2
|
Conteh L, Shuford K, Agboraw E, Kont M, Kolaczinski J, Patouillard E. Costs and Cost-Effectiveness of Malaria Control Interventions: A Systematic Literature Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1213-1222. [PMID: 34372987 PMCID: PMC8324482 DOI: 10.1016/j.jval.2021.01.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 05/05/2023]
Abstract
OBJECTIVES To systematically review the literature on the unit cost and cost-effectiveness of malaria control. METHODS Ten databases and gray literature sources were searched to identify evidence relevant to the period 2005 to 2018. Studies with primary financial or economic cost data from malaria endemic countries that took a provider, provider and household, or societal perspective were included. RESULTS We identified 103 costing studies. The majority of studies focused on individual rather than combined interventions, notably insecticide-treated bed nets and treatment, and commonly took a provider perspective. A third of all studies took place in 3 countries. The median provider economic cost of protecting 1 person per year ranged from $1.18 to $5.70 with vector control and from $0.53 to $5.97 with chemoprevention. The median provider economic cost per case diagnosed with rapid diagnostic tests was $6.06 and per case treated $9.31 or $89.93 depending on clinical severity. Other interventions did not share enough similarities to be summarized. Cost drivers were rarely reported. Cost-effectiveness of malaria control was reiterated, but care in methodological and reporting standards is required to enhance data transferability. CONCLUSIONS Important information that can support resource allocation was reviewed. Given the variability in methods and reporting, global efforts to follow existing standards are required for the evidence to be most useful outside their study context, supplemented by guidance on options for transferring existing data across settings.
Collapse
Affiliation(s)
- Lesong Conteh
- Department of Health Policy, London School of Economics and Political Science, London, England, UK; School of Public Health, Imperial College London, St Mary's Campus, Paddington, England, UK
| | - Kathryn Shuford
- Department of Health Policy, London School of Economics and Political Science, London, England, UK
| | - Efundem Agboraw
- Vector Biology, Liverpool School of Tropical Medicine, Liverpool, England, UK
| | - Mara Kont
- Department of Infectious Disease Epidemiology, MRC Centre for Global Infectious Disease Analysis, Imperial College London, England, UK
| | - Jan Kolaczinski
- Department of the Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Edith Patouillard
- Department of Health Systems Governance and Financing, World Health Organization, Geneva, Switzerland.
| |
Collapse
|
4
|
Moore BR, Davis WA, Clarke PM, Robinson LJ, Laman M, Davis TME. Cost-effectiveness of artemisinin-naphthoquine versus artemether-lumefantrine for the treatment of uncomplicated malaria in Papua New Guinean children. Malar J 2017; 16:438. [PMID: 29084540 PMCID: PMC5663042 DOI: 10.1186/s12936-017-2081-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/21/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A recent randomized trial showed that artemisinin-naphthoquine (AN) was non-inferior to artemether-lumefantrine (AL) for falciparum malaria and superior for vivax malaria in young Papua New Guinean children. The aim of this study was to compare the cost-effectiveness of these two regimens. METHODS An incremental cost-effectiveness analysis was performed using data from 231 children with Plasmodium falciparum and/or Plasmodium vivax infections in an open-label, randomized, parallel-group trial. Recruited children were randomized 1:1 to receive once daily AN for 3 days with water or twice daily AL for 3 days given with fat. World Health Organisation (WHO) definitions were used to determine clinical/parasitological outcomes. The cost of transport between the home and clinic, plus direct health-care costs, served as a basis for determining each regimen's incremental cost per incremental treatment success relative to AL by Day 42 and its cost per life year saved. RESULTS In the usual care setting, AN was more effective for the treatment of uncomplicated malaria in children aged 0.5-5.9 years. AL and AN were equally efficacious for the treatment of falciparum malaria, however AN had increased anti-malarial treatment costs per patient of $10.46, compared with AL. AN was the most effective regimen for treatment of vivax malaria, but had increased treatment costs of $14.83 per treatment success compared with AL. CONCLUSIONS Whilst AN has superior overall efficacy for the treatment of uncomplicated malaria in PNG children, AL was the less costly regimen. An indicative extrapolation estimated the cost per life year saved by using AN instead of AL to treat uncomplicated malaria to be $12,165 for girls and $12,469 for boys (discounted), which means AN may not be cost-effective and affordable for PNG at current cost. However, AN may become acceptable should it become WHO prequalified and/or should donated/subsidized drug supply become available.
Collapse
Affiliation(s)
- Brioni R Moore
- School of Pharmacy, Curtin University of Technology, Perth, WA, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Wendy A Davis
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Philip M Clarke
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Leanne J Robinson
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea.,Burnet Institute, Parkville, Melbourne, VIC, Australia.,Division of Population Health and Immunity, Walter and Eliza Hall Institute, Parkville, VIC, Australia
| | - Moses Laman
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Timothy M E Davis
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.
| |
Collapse
|
8
|
Mori AT, Norheim OF, Robberstad B. Budget Impact Analysis of Using Dihydroartemisinin-Piperaquine to Treat Uncomplicated Malaria in Children in Tanzania. PHARMACOECONOMICS 2016; 34:303-14. [PMID: 26521172 PMCID: PMC4766228 DOI: 10.1007/s40273-015-0344-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND AND OBJECTIVE Dihydroartemisinin-piperaquine (DhP) is a very cost effective anti-malarial drug. The aim of this study was to predict the budget impact of using DhP as a first- or second-line drug to treat uncomplicated malaria in children in Tanzania. METHODS A dynamic Markov decision model was developed based on clinical and epidemiological data to estimate annual cases of malaria in children aged under 5 years. The model was used to predict the budget impact of introducing DhP as the first- or second-line anti-malarial drug, from the perspective of the National Malaria Control Program in 2014; thus, only the cost of drugs and diagnostics were considered. Probabilistic sensitivity analysis was performed to explore overall uncertainties in input parameters. RESULTS The model predicts that the policy that uses artemether-lumefantrine (AL) and DhP as the first- and second-line drugs (AL + DhP), respectively, will save about $US64,423 per year, while achieving a 3% reduction in the number of malaria cases, compared with that of AL + quinine. However, the policy that uses DhP as the first-line drug (DhP + AL) will consume an additional $US780,180 per year, while achieving a further 5% reduction in the number of malaria cases, compared with that of AL + DhP. CONCLUSION The use of DhP as the second-line drug to treat uncomplicated malaria in children in Tanzania is slightly cost saving. However, the policy that uses DhP as the first-line drug is somewhat more expensive but with more health benefits.
Collapse
Affiliation(s)
- Amani Thomas Mori
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway.
- Muhimbili University of Health and Allied Sciences, P.O. Box 65001, 11103, Dar es Salaam, Tanzania.
| | - Ole Frithjof Norheim
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway.
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway.
| | - Bjarne Robberstad
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway.
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, P.O. Box 7804, 5020, Bergen, Norway.
| |
Collapse
|
9
|
Pfeil J, Borrmann S, Bassat Q, Mulenga M, Talisuna A, Tozan Y. An Economic Evaluation of the Posttreatment Prophylactic Effect of Dihydroartemisinin-Piperaquine Versus Artemether-Lumefantrine for First-Line Treatment of Plasmodium falciparum Malaria Across Different Transmission Settings in Africa. Am J Trop Med Hyg 2015; 93:961-6. [PMID: 26240155 DOI: 10.4269/ajtmh.15-0162] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/24/2015] [Indexed: 01/17/2023] Open
Abstract
Malaria disproportionately affects young children. Clinical trials in African children showed that dihydroartemisinin-piperaquine (DP) is an effective antimalarial and has a longer posttreatment prophylactic (PTP) effect against reinfections than other artemisinin-based combination therapies, including artemether-lumefantrine (AL). Using a previously developed Markov model and individual patient data from a multicenter African drug efficacy trial, we assessed the economic value of the PTP effect of DP versus AL in pediatric malaria patients from health-care provider's perspective in low-to-moderate and moderate-to-high transmission settings under different drug co-payment scenarios. In low-to-moderate transmission settings, first-line treatment with DP was highly cost-effective with an incremental cost-effectiveness ratio of US$5 (95% confidence interval [CI] = -76 to 196) per disability-adjusted life year (DALY) averted. In moderate-to-high transmission settings, DP first-line treatment led to a mean cost saving of US$1.09 (95% CI = -0.88 to 3.85) and averted 0.05 (95% CI = -0.08 to 0.22) DALYs per child per year. Our results suggested that DP might be superior to AL for first-line treatment of uncomplicated childhood malaria across a range of transmission settings in Africa.
Collapse
Affiliation(s)
- Johannes Pfeil
- Parasitology Unit, Department for Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany; General Pediatrics Unit, Center for Childhood and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; German Centre for Infectious Diseases (DZIF), University of Tübingen, Tübingen, Germany; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Tropical Diseases Research Centre, Ndola, Zambia; Department of Public Health Research, University of Oxford-KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Steinhardt School of Culture, Education and Human Development, New York University, New York, New York; College of Global Public Health, New York University, New York, New York; Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany
| | - Steffen Borrmann
- Parasitology Unit, Department for Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany; General Pediatrics Unit, Center for Childhood and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; German Centre for Infectious Diseases (DZIF), University of Tübingen, Tübingen, Germany; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Tropical Diseases Research Centre, Ndola, Zambia; Department of Public Health Research, University of Oxford-KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Steinhardt School of Culture, Education and Human Development, New York University, New York, New York; College of Global Public Health, New York University, New York, New York; Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany
| | - Quique Bassat
- Parasitology Unit, Department for Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany; General Pediatrics Unit, Center for Childhood and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; German Centre for Infectious Diseases (DZIF), University of Tübingen, Tübingen, Germany; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Tropical Diseases Research Centre, Ndola, Zambia; Department of Public Health Research, University of Oxford-KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Steinhardt School of Culture, Education and Human Development, New York University, New York, New York; College of Global Public Health, New York University, New York, New York; Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany
| | - Modest Mulenga
- Parasitology Unit, Department for Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany; General Pediatrics Unit, Center for Childhood and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; German Centre for Infectious Diseases (DZIF), University of Tübingen, Tübingen, Germany; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Tropical Diseases Research Centre, Ndola, Zambia; Department of Public Health Research, University of Oxford-KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Steinhardt School of Culture, Education and Human Development, New York University, New York, New York; College of Global Public Health, New York University, New York, New York; Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany
| | - Ambrose Talisuna
- Parasitology Unit, Department for Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany; General Pediatrics Unit, Center for Childhood and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; German Centre for Infectious Diseases (DZIF), University of Tübingen, Tübingen, Germany; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Tropical Diseases Research Centre, Ndola, Zambia; Department of Public Health Research, University of Oxford-KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Steinhardt School of Culture, Education and Human Development, New York University, New York, New York; College of Global Public Health, New York University, New York, New York; Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany
| | - Yesim Tozan
- Parasitology Unit, Department for Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany; General Pediatrics Unit, Center for Childhood and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; German Centre for Infectious Diseases (DZIF), University of Tübingen, Tübingen, Germany; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Tropical Diseases Research Centre, Ndola, Zambia; Department of Public Health Research, University of Oxford-KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Steinhardt School of Culture, Education and Human Development, New York University, New York, New York; College of Global Public Health, New York University, New York, New York; Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany
| |
Collapse
|