@article{fdi:010064198,
  title = {{E}conomic evaluation of an alternative drug to sulfadoxine-pyrimethamine as intermittent preventive treatment of malaria in pregnancy},
  author = {{S}icuri, {E}. and {F}ernandes, {S}. and {M}acete, {E}. and {G}onzalez, {R}. and {M}ombo-{N}goma, {G}. and {M}assougbodgi, {A}. and {A}bdulla, {S}. and {K}uwawenaruwa, {A}. and {K}atana, {A}. and {D}esai, {M}. and {C}ot, {M}ichel and {R}amharter, {M}. and {K}remsner, {P}. and {S}lustker, {L}. and {A}ponte, {J}. and {H}anson, {K}. and {M}enendez, {C}.},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground {I}ntermittent preventive treatment in pregnancy ({IPT}p) with sulfadoxine-pyrimethamine ({SP}) is recommended in {HIV}-negative women to avert malaria, while this relies on cotrimoxazole prophylaxis ({CTX}p) in {HIV}-positive women. {A}lternative antimalarials are required in areas where parasite resistance to antifolate drugs is high. {T}he cost-effectiveness of {IPT}p with alternative drugs is needed to inform policy. {M}ethods {T}he cost-effectiveness of 2-dose {IPT}p-mefloquine ({MQ}) was compared with {IPT}p-{SP} in {HIV}-negative women ({B}enin, {G}abon, {M}ozambique and {T}anzania). {I}n {HIV}-positive women the cost-effectiveness of 3-dose {IPT}p-{MQ} added to {CTX}p was compared with {CTX}p alone ({K}enya, {M}ozambique and {T}anzania). {T}he outcomes used were maternal clinical malaria, anaemia at delivery and non-obstetric hospital admissions. {T}he poor tolerability to {MQ} was included as the value of women's loss of working days. {I}ncremental cost-effectiveness ratios ({ICER}s) were calculated and threshold analysis undertaken. {R}esults {F}or {HIV}-negative women, the {ICER} for {IPT}p-{MQ} versus {IPT}p-{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 {G}abon were included or not. {F}or {HIV}-positive women, the {ICER} per {DALY} averted for {IPT}p-{MQ} added to {CTX}p, versus {CTX}p alone was 6.96 {US}$ (95%{CI} 4.22; 9.70). {I}n {HIV}-negative women, moderate shifts of variables such as malaria incidence, drug cost, and {IPT}p efficacy increased the {ICER}s above the cost-effectiveness threshold. {I}n {HIV}-positive women the intervention remained cost-effective for a substantial (up to 21 times) increase in cost per tablet. {C}onclusions {A}ddition of {IPT}p with an effective antimalarial to {CTX}p was very cost-effective in {HIV}-positive women. {IPT}p with an efficacious antimalarial was more cost-effective than {IPT}p-{SP} in {HIV}-negative women. {H}owever, the poor tolerability of {MQ} does not favour its use as {IPT}p. {R}egardless of {HIV} status, prevention of malaria in pregnancy with a highly efficacious, well tolerated antimalarial would be cost-effective despite its high price.},
  keywords = {{KENYA} ; {TANZANIE} ; {MOZAMBIQUE}},
  booktitle = {},
  journal = {{P}los {O}ne},
  volume = {10},
  numero = {4},
  pages = {e0125072 [23 p.]},
  ISSN = {1932-6203},
  year = {2015},
  DOI = {10.1371/journal.pone.0125072},
  URL = {https://www.documentation.ird.fr/hor/fdi:010064198},
}