dc.contributor.author |
Sicuri, Elisa |
dc.contributor.author |
Fernandes, Silke |
dc.contributor.author |
Macete, Eusébio |
dc.contributor.author |
González, Raquel |
dc.contributor.author |
Mombo-Ngoma, Ghyslain |
dc.contributor.author |
Massougbodji, Achille |
dc.contributor.author |
Abdulla, Salim |
dc.contributor.author |
Kuwawenaruwa, August |
dc.contributor.author |
Katana, Abraham |
dc.contributor.author |
Desai, Meghna |
dc.contributor.author |
Cot, Michel |
dc.contributor.author |
Ramharter, Michael |
dc.contributor.author |
Kremsner, Peter G. |
dc.contributor.author |
Slutsker, Laurence |
dc.contributor.author |
Aponte, John J. |
dc.contributor.author |
Hanson, Kara |
dc.contributor.author |
Menéndez, Clara |
dc.date |
2016-02-03T13:41:59Z |
dc.date |
2016-02-03T13:41:59Z |
dc.date |
2015-04-27 |
dc.date |
2016-02-02T15:33:49Z |
dc.identifier.citation |
1932-6203 |
dc.identifier.uri |
http://hdl.handle.net/2445/69197 |
dc.format |
23 p. |
dc.format |
application/pdf |
dc.language.iso |
eng |
dc.publisher |
Public Library of Science (PLoS) |
dc.relation |
Reproducció del document publicat a:
http://dx.doi.org/10.1371/journal.pone.0125072 |
dc.relation |
PLoS One, 2015, vol. 10, num. 4, p. e0125072 |
dc.relation |
http://dx.doi.org/10.1371/journal.pone.0125072 |
dc.rights |
CC0 (c) Sicuri et al., 2015 |
dc.rights |
info:eu-repo/semantics/openAccess |
dc.rights |
http://creativecommons.org/publicdomain/zero/1.0/ |
dc.subject |
Malària |
dc.subject |
Persones seropositives |
dc.subject |
Embaràs |
dc.subject |
Assaigs clínics |
dc.subject |
Malaria |
dc.subject |
HIV-positive persons |
dc.subject |
Pregnancy |
dc.subject |
Clinical trials |
dc.title |
Economic Evaluation of an Alternative Drug to Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment of Malaria in Pregnancy |
dc.type |
info:eu-repo/semantics/article |
dc.type |
info:eu-repo/semantics/publishedVersion |
dc.description.abstract |
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. |