PMID- 20559558
OWN - NLM
STAT- MEDLINE
DCOM- 20100901
LR  - 20240313
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 5
IP  - 6
DP  - 2010 Jun 15
TI  - The cost-effectiveness of intermittent preventive treatment for malaria in 
      infants in Sub-Saharan Africa.
PG  - e10313
LID - 10.1371/journal.pone.0010313 [doi]
LID - e10313
AB  - BACKGROUND: Intermittent preventive treatment in infants (IPTi) has been shown to 
      decrease clinical malaria by approximately 30% in the first year of life and is a 
      promising malaria control strategy for Sub-Saharan Africa which can be delivered 
      alongside the Expanded Programme on Immunisation (EPI). To date, there have been 
      limited data on the cost-effectiveness of this strategy using sulfadoxine 
      pyrimethamine (SP) and no published data on cost-effectiveness using other 
      antimalarials. METHODS: We analysed data from 5 countries in sub-Saharan Africa 
      using a total of 5 different IPTi drug regimens; SP, mefloquine (MQ), 3 days of 
      chlorproguanil-dapsone (CD), SP plus 3 days of artesunate (SP-AS3) and 3 days of 
      amodiaquine-artesunate (AQ3-AS3).The cost per malaria episode averted and cost 
      per Disability-Adjusted Life-Year (DALY) averted were modeled using both trial 
      specific protective efficacy (PE) for all IPTi drugs and a pooled PE for IPTi 
      with SP, malaria incidence, an estimated malaria case fatality rate of 1.57%, 
      IPTi delivery costs and country specific provider and household malaria treatment 
      costs. FINDINGS: In sites where IPTi had a significant effect on reducing 
      malaria, the cost per episode averted for IPTi-SP was very low, USD 1.36-4.03 
      based on trial specific data and USD 0.68-2.27 based on the pooled analysis. For 
      IPTi using alternative antimalarials, the lowest cost per case averted was for 
      AQ3-AS3 in western Kenya (USD 4.62) and the highest was for MQ in Korowge, 
      Tanzania (USD 18.56). Where efficacious, based only on intervention costs, IPTi 
      was shown to be cost effective in all the sites and highly cost-effective in all 
      but one of the sites, ranging from USD 2.90 (Ifakara, Tanzania with SP) to USD 
      39.63 (Korogwe, Tanzania with MQ) per DALY averted. In addition, IPTi reduced 
      health system costs and showed significant savings to households from malaria 
      cases averted. A threshold analysis showed that there is room for the 
      IPTi-efficacy to fall and still remain highly cost effective in all sites where 
      IPTi had a statistically significant effect on clinical malaria. CONCLUSIONS: 
      IPTi delivered alongside the EPI is a highly cost effective intervention against 
      clinical malaria with a range of drugs in a range of malaria transmission 
      settings. Where IPTi did not have a statistically significant impact on malaria, 
      generally in low transmission sites, it was not cost effective.
FAU - Conteh, Lesong
AU  - Conteh L
AD  - Swiss Tropical and Public Health Institute, Basel, Switzerland. 
      lesong.conteh@lshtm.ac.uk
FAU - Sicuri, Elisa
AU  - Sicuri E
FAU - Manzi, Fatuma
AU  - Manzi F
FAU - Hutton, Guy
AU  - Hutton G
FAU - Obonyo, Benson
AU  - Obonyo B
FAU - Tediosi, Fabrizio
AU  - Tediosi F
FAU - Biao, Prosper
AU  - Biao P
FAU - Masika, Paul
AU  - Masika P
FAU - Matovu, Fred
AU  - Matovu F
FAU - Otieno, Peter
AU  - Otieno P
FAU - Gosling, Roly D
AU  - Gosling RD
FAU - Hamel, Mary
AU  - Hamel M
FAU - Odhiambo, Frank O
AU  - Odhiambo FO
FAU - Grobusch, Martin P
AU  - Grobusch MP
FAU - Kremsner, Peter G
AU  - Kremsner PG
FAU - Chandramohan, Daniel
AU  - Chandramohan D
FAU - Aponte, John J
AU  - Aponte JJ
FAU - Egan, Andrea
AU  - Egan A
FAU - Schellenberg, David
AU  - Schellenberg D
FAU - Macete, Eusebio
AU  - Macete E
FAU - Slutsker, Laurence
AU  - Slutsker L
FAU - Newman, Robert D
AU  - Newman RD
FAU - Alonso, Pedro
AU  - Alonso P
FAU - Menendez, Clara
AU  - Menendez C
FAU - Tanner, Marcel
AU  - Tanner M
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20100615
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Antimalarials)
RN  - 0 (Drug Combinations)
RN  - 37338-39-9 (fanasil, pyrimethamine drug combination)
RN  - 88463U4SM5 (Sulfadoxine)
RN  - Z3614QOX8W (Pyrimethamine)
SB  - IM
MH  - Africa South of the Sahara/epidemiology
MH  - Antimalarials/administration & dosage/*economics
MH  - *Cost-Benefit Analysis
MH  - Drug Combinations
MH  - Humans
MH  - Infant
MH  - Malaria/epidemiology/*prevention & control
MH  - Pyrimethamine/administration & dosage/*economics
MH  - Sulfadoxine/administration & dosage/*economics
PMC - PMC2886103
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2010/06/19 06:00
MHDA- 2010/09/02 06:00
PMCR- 2010/06/15
CRDT- 2010/06/19 06:00
PHST- 2009/08/12 00:00 [received]
PHST- 2010/02/18 00:00 [accepted]
PHST- 2010/06/19 06:00 [entrez]
PHST- 2010/06/19 06:00 [pubmed]
PHST- 2010/09/02 06:00 [medline]
PHST- 2010/06/15 00:00 [pmc-release]
AID - 09-PONE-RA-12209R1 [pii]
AID - 10.1371/journal.pone.0010313 [doi]
PST - epublish
SO  - PLoS One. 2010 Jun 15;5(6):e10313. doi: 10.1371/journal.pone.0010313.