PMID- 21490967
OWN - NLM
STAT- MEDLINE
DCOM- 20110825
LR  - 20231105
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 6
IP  - 4
DP  - 2011 Apr 7
TI  - Determinants of the cost-effectiveness of intermittent preventive treatment for 
      malaria in infants and children.
PG  - e18391
LID - 10.1371/journal.pone.0018391 [doi]
LID - e18391
AB  - BACKGROUND: Trials of intermittent preventive treatment in infants (IPTi) and 
      children (IPTc) have shown promising results in reducing malaria episodes but 
      with varying efficacy and cost-effectiveness. The effects of different 
      intervention and setting characteristics are not well known. We simulate the 
      effects of the different target age groups and delivery channels, seasonal or 
      year-round delivery, transmission intensity, seasonality, proportions of malaria 
      fevers treated and drug characteristics. METHODS: We use a dynamic, 
      individual-based simulation model of Plasmodium falciparum malaria epidemiology, 
      antimalarial drug action and case management to simulate DALYs averted and the 
      cost per DALY averted by IPTi and IPTc. IPT cost components were estimated from 
      economic studies alongside trials. RESULTS: IPTi and IPTc were predicted to be 
      cost-effective in most of the scenarios modelled. The cost-effectiveness is 
      driven by the impact on DALYs, particularly for IPTc, and the low costs, 
      particularly for IPTi which uses the existing delivery strategy, EPI. 
      Cost-effectiveness was predicted to decrease with low transmission, badly timed 
      seasonal delivery in a seasonal setting, short-acting and more expensive drugs, 
      high frequencies of drug resistance and high levels of treatment of malaria 
      fevers. Seasonal delivery was more cost-effective in seasonal settings, and 
      year-round in constant transmission settings. The difference was more pronounced 
      for IPTc than IPTi due to the different proportions of fixed costs and also 
      different assumed drug spacing during the transmission season. The number of 
      DALYs averted was predicted to decrease as a target five-year age-band for IPTc 
      was shifted from children under 5 years into older ages, except at low 
      transmission intensities. CONCLUSIONS: Modelling can extend the information 
      available by predicting impact and cost-effectiveness for scenarios, for outcomes 
      and for multiple strategies where, for practical reasons, trials cannot be 
      carried out. Both IPTi and IPTc are generally cost-effective but could be 
      rendered cost-ineffective by characteristics of the setting, drug or 
      implementation.
FAU - Ross, Amanda
AU  - Ross A
AD  - Swiss Tropical and Public Health Institute, Basel, Switzerland. 
      amanda.ross@unibas.ch
FAU - Maire, Nicolas
AU  - Maire N
FAU - Sicuri, Elisa
AU  - Sicuri E
FAU - Smith, Thomas
AU  - Smith T
FAU - Conteh, Lesong
AU  - Conteh L
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20110407
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Antimalarials)
SB  - IM
MH  - Antimalarials/*economics/therapeutic use
MH  - Child, Preschool
MH  - Cost-Benefit Analysis
MH  - Female
MH  - Humans
MH  - Infant
MH  - Malaria
MH  - Malaria, Falciparum/epidemiology/*prevention & control
MH  - Male
MH  - Models, Theoretical
PMC - PMC3072385
COIS- Competing Interests: The authors have declared that no competing interests exist.
EDAT- 2011/04/15 06:00
MHDA- 2011/08/27 06:00
PMCR- 2011/04/07
CRDT- 2011/04/15 06:00
PHST- 2010/12/03 00:00 [received]
PHST- 2011/02/28 00:00 [accepted]
PHST- 2011/04/15 06:00 [entrez]
PHST- 2011/04/15 06:00 [pubmed]
PHST- 2011/08/27 06:00 [medline]
PHST- 2011/04/07 00:00 [pmc-release]
AID - PONE-D-10-06009 [pii]
AID - 10.1371/journal.pone.0018391 [doi]
PST - epublish
SO  - PLoS One. 2011 Apr 7;6(4):e18391. doi: 10.1371/journal.pone.0018391.