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Increasing resistance of Plasmodium falciparum malaria to antimalarial drugs is posing a major threat to the global effort to "Roll Back Malaria". Chloroquine and sulfadoxine-pyrimethamine (SP) are being rendered increasingly ineffective, resulting in increasing morbidity, mortality, and economic and social costs. One strategy advocated for delaying the development of resistance to the remaining armory of effective drugs is the wide-scale deployment of artemisinin-based combination therapy. However, the cost of these combinations are higher than most of the currently used monotherapies and alternative non-artemisinin-based combinations. In addition, uncertainty about the actual impact in real-life settings has made them a controversial choice for first-line treatment. The difficulties in measuring the burden of drug resistance and predicting the impact of strategies aimed at its reduction are outlined, and a mathematical model is introduced that is being designed to address these issues and to clarify policy options.
Received August 28, 2003. Accepted for publication February 27, 2004.
Acknowledgments: We are grateful to Dr. Karen Barnes for her support and contributions.
Financial support: This study is part of the Wellcome Trust–Mahidol University–Oxford Tropical Medicine Research Program funded by the Wellcome Trust of Great Britain. Wirichada Pongtavornpinyo is supported by the World Health Organization Tropical Disease Research Program, Ian M. Hastings is supported by the Department for International Development (DFID)-funded Malaria Knowledge Program of the Liverpool School of Tropical Medicine, and Anne J. Mills is supported by the DFID-funded Health Economics and Financing Program of the London School of Hygiene and Tropical Medicine.
Authors’ addresses: Shunmay Yeung, Wirichida Pongtavornpinyo, and Nicholas J. White, Wellcome Trust-Mahidol University-Oxford Tropical Medicine Research Program, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand, Telephone: 66-2-246-0832, Fax: 66-2-246-7795, E-mails: shunmay. yeung{at}lshtm.ac.uk or shunmay{at}hotmail.com, pan{at}tropmedres.ac and nickw{at}tropmedres.ac. Ian M. Hastings, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, United Kingdom, Telephone: 44- 151-705-3183, Fax: 44-151-705-3371, E-mail: hastings{at}liverpool.ac.uk. Anne J, Mills, Health Economics and Financing Program, Department of Public Health and Policy, Health Policy Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, E-mail: anne.mills{at}lshtm.ac.uk.
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