%0 Journal Article
%9 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES
%A Sicuri, E.
%A Fernandes, S.
%A Macete, E.
%A Gonzalez, R.
%A Mombo-Ngoma, G.
%A Massougbodgi, A.
%A Abdulla, S.
%A Kuwawenaruwa, A.
%A Katana, A.
%A Desai, M.
%A Cot, Michel
%A Ramharter, M.
%A Kremsner, P.
%A Slustker, L.
%A Aponte, J.
%A Hanson, K.
%A Menendez, C.
%T Economic evaluation of an alternative drug to sulfadoxine-pyrimethamine as intermittent preventive treatment of malaria in pregnancy
%D 2015
%L fdi:010064198
%G ENG
%J Plos One
%@ 1932-6203
%K KENYA ; TANZANIE ; MOZAMBIQUE
%M ISI:000353659100094
%N 4
%P e0125072 [23 ]
%R 10.1371/journal.pone.0125072
%U https://www.documentation.ird.fr/hor/fdi:010064198
%> https://horizon.documentation.ird.fr/exl-doc/pleins_textes/divers17-08/010064198.pdf
%V 10
%W Horizon (IRD)
%X 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.
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