dc.contributor.author |
Fernandes, Silke |
dc.contributor.author |
Sicuri, Elisa |
dc.contributor.author |
Halimatou, Diawara |
dc.contributor.author |
Akazili, James |
dc.contributor.author |
Bojang, Kalifa |
dc.contributor.author |
Chandramohan, Daniel |
dc.contributor.author |
Coulibaly, Sheikh |
dc.contributor.author |
Diawara, Sory Ibrahim |
dc.contributor.author |
Kayentao, Kassoum |
dc.contributor.author |
Kuile, Feiko ter |
dc.contributor.author |
Magnussen, Pascal |
dc.contributor.author |
Tagbor, Harry |
dc.contributor.author |
Williams, John |
dc.contributor.author |
Woukeu, Arouna |
dc.contributor.author |
Cairns, Matthew |
dc.contributor.author |
Greenwood, Brian |
dc.contributor.author |
Hanson, Kara |
dc.date |
2016-10-07T13:42:04Z |
dc.date |
2016-10-07T13:42:04Z |
dc.date |
2016-09-23 |
dc.date |
2016-10-05T18:01:07Z |
dc.identifier.citation |
1475-2875 |
dc.identifier.uri |
http://hdl.handle.net/2445/102456 |
dc.format |
13 p. |
dc.format |
application/pdf |
dc.language.iso |
eng |
dc.publisher |
BioMed Central |
dc.relation |
Reproducció del document publicat a: http://dx.doi.org/10.1186/s12936-016-1539-4 |
dc.relation |
Malaria Journal, 2016, vol. 15, num. 493 |
dc.relation |
http://dx.doi.org/10.1186/s12936-016-1539-4 |
dc.rights |
cc by (c) Fernandes et al., 2016 |
dc.rights |
info:eu-repo/semantics/openAccess |
dc.rights |
http://creativecommons.org/licenses/by/3.0/es/ |
dc.subject |
Malària |
dc.subject |
Embaràs |
dc.subject |
Malaria |
dc.subject |
Pregnancy |
dc.title |
Cost effectiveness of intermittent screening followed by
treatment versus intermittent preventive treatment during
pregnancy in West Africa: analysis and modelling of results from
a non-inferiority trial |
dc.type |
info:eu-repo/semantics/article |
dc.type |
info:eu-repo/semantics/publishedVersion |
dc.description.abstract |
Background: Emergence of high-grade sulfadoxine-pyrimethamine (SP) resistance in parts of Africa has led to growing concerns about the efficacy of intermittent preventive treatment of malaria during pregnancy (IPTp) with SP. The incremental cost-effectiveness of intermittent screening and treatment (ISTp) with artemether-lumefantrine (AL) as an alternative strategy to IPTp-SP was estimated followed by a simulation of the effects on cost-effectiveness of decreasing efficacy of IPTp-SP due to SP resistance. The analysis was based on results from a multi-centre, non-inferiority trial conducted in West Africa. Methods: A decision tree model was analysed from a health provider perspective. Model parameters for all trial countries with appropriate ranges and distributions were used in a probabilistic sensitivity analysis. Simulations were performed in hypothetical cohorts of 1000 pregnant women who received either ISTp-AL or IPTp-SP. In addition a cost-consequences analysis was conducted. Trial estimates were used to calculate disability-adjusted-life-years (DALYs) for low birth weight and severe/moderate anaemia (both shown to be non-inferior for ISTp-AL) and clinical malaria (inferior for ISTp-AL). Cost estimates were obtained from observational studies, health facility costings and public procurement databases. Results were calculated as incremental cost per DALY averted. Finally, the cost-effectiveness changes with decreasing SP efficacy were explored by simulation. Results: Relative to IPTp-SP, delivering ISTp-AL to 1000 pregnant women cost US$ 4966.25 more (95 % CI US$ 3703.53; 6376.83) and led to a small excess of 28.36 DALYs (95 % CI −75.78; 134.18), with LBW contributing 81.3 % of this difference. The incremental cost-effectiveness ratio was −175.12 (95 % CI −1166.29; 1267.71) US$/DALY averted. Simulations show that cost-effectiveness of ISTp-AL increases as the efficacy of IPTp-SP decreases, though the specific threshold at which ISTp-AL becomes cost-effective depends on assumptions about the contribution of bed nets to malaria control, bed net coverage and the willingness-to-pay threshold used. Conclusions: At SP efficacy levels currently observed in the trial settings it would not be cost-effective to switch from IPTp-SP to ISTp-AL, mainly due to the substantially higher costs of ISTp-AL and limited difference in outcomes. The modelling results indicate thresholds below which IPT-SP efficacy must fall for ISTp-AL to become a cost-effective option for the prevention of malaria in pregnancy. |