Sicuri E., Fernandes S., Macete E., Gonzalez R., Mombo-Ngoma G., Massougbodgi A., Abdulla S., Kuwawenaruwa A., Katana A., Desai M., Cot Michel, Ramharter M., Kremsner P., Slustker L., Aponte J., Hanson K., Menendez C. (2015). Economic evaluation of an alternative drug to sulfadoxine-pyrimethamine as intermittent preventive treatment of malaria in pregnancy. Plos One, 10 (4), p. e0125072 [23 p.]. ISSN 1932-6203.
Titre du document
Economic evaluation of an alternative drug to sulfadoxine-pyrimethamine as intermittent preventive treatment of malaria in pregnancy
Année de publication
2015
Auteurs
Sicuri E., Fernandes S., Macete E., Gonzalez R., Mombo-Ngoma G., Massougbodgi A., Abdulla S., Kuwawenaruwa A., Katana A., Desai M., Cot Michel, Ramharter M., Kremsner P., Slustker L., Aponte J., Hanson K., Menendez C.
Source
Plos One, 2015,
10 (4), p. e0125072 [23 p.] ISSN 1932-6203
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.
Plan de classement
Entomologie médicale / Parasitologie / Virologie [052]
;
Santé : aspects socioculturels, économiques et politiques [056]
Description Géographique
KENYA ; TANZANIE ; MOZAMBIQUE
Localisation
Fonds IRD [F B010064198]
Identifiant IRD
fdi:010064198
