Autor/a:
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Fernandes, Silke; Sicuri, Elisa; Kayentao, Kassoum; Eijk, Anna Maria van; Hill, Jenny; Webster, Jayne; Were, Vincent; Akazili, James; Madanitsa, Mwayi; Ter Kuile, Feiko O.; Hanson, Kara
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Abstract:
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BACKGROUND: In 2012, WHO changed its recommendation for
intermittent preventive treatment of malaria during pregnancy
(IPTp) from two doses to monthly doses of
sulfadoxine-pyrimethamine during the second and third
trimesters, but noted the importance of a cost-effectiveness
analysis to lend support to the decision of policy makers. We
therefore estimated the incremental cost-effectiveness of IPTp
with three or more (IPTp-SP3+) versus two doses of
sulfadoxine-pyrimethamine (IPTp-SP2). METHODS: For this
analysis, we used data from a 2013 meta-analysis of seven
studies in sub-Saharan Africa. We developed a decision tree
model with a lifetime horizon. We analysed the base case from a
societal perspective. We did deterministic and probabilistic
sensitivity analyses with appropriate parameter ranges and
distributions for settings with low, moderate, and high
background risk of low birthweight, and did a separate analysis
for HIV-negative women. Parameters in the model were obtained
for all countries included in the original meta-analysis. We did
simulations in hypothetical cohorts of 1000 pregnant women
receiving either IPTp-SP3+ or IPTp-SP2. We calculated
disability-adjusted life-years (DALYs) for low birthweight,
severe to moderate anaemia, and clinical malaria. We calculated
cost estimates from data obtained in observational studies, exit
surveys, and from public procurement databases. We give
financial and economic costs in constant 2012 US$. The main
outcome measure was the incremental cost per DALY averted.
FINDINGS: The delivery of IPTp-SP3+ to 1000 pregnant women
averted 113.4 DALYs at an incremental cost of $825.67 producing
an incremental cost-effectiveness ratio (ICER) of $7.28 per DALY
averted. The results remained robust in the deterministic
sensitivity analysis. In the probabilistic sensitivity analyses,
the ICER was $7.7 per DALY averted for moderate risk of low
birthweight, $19.4 per DALY averted for low risk, and $4.0 per
DALY averted for high risk. The ICER for HIV-negative women was
$6.2 per DALY averted. INTERPRETATION: Our findings lend strong
support to the WHO guidelines that recommend a monthly dose of
IPTp-SP from the second trimester onwards. |