Volume 93, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Malaria disproportionately affects young children. Clinical trials in African children showed that dihydroartemisinin–piperaquine (DP) is an effective antimalarial and has a longer posttreatment prophylactic (PTP) effect against reinfections than other artemisinin-based combination therapies, including artemether–lumefantrine (AL). Using a previously developed Markov model and individual patient data from a multicenter African drug efficacy trial, we assessed the economic value of the PTP effect of DP versus AL in pediatric malaria patients from health-care provider's perspective in low-to-moderate and moderate-to-high transmission settings under different drug co-payment scenarios. In low-to-moderate transmission settings, first-line treatment with DP was highly cost-effective with an incremental cost-effectiveness ratio of US$5 (95% confidence interval [CI] = −76 to 196) per disability-adjusted life year (DALY) averted. In moderate-to-high transmission settings, DP first-line treatment led to a mean cost saving of US$1.09 (95% CI = −0.88 to 3.85) and averted 0.05 (95% CI = −0.08 to 0.22) DALYs per child per year. Our results suggested that DP might be superior to AL for first-line treatment of uncomplicated childhood malaria across a range of transmission settings in Africa.


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  1. World Health Organization, 2014. World Malaria Report 2014. ISBN 9789241564830. [Google Scholar]
  2. World Health Organization, 2010. Guidelines for the Treatment of Malaria, 2nd edition. ISBN 9789241547925. [Google Scholar]
  3. World Health Organization, 2011. Global Supply of Artemether-Lumefantrine before, during, and after the Memorandum of Understanding between WHO and Novartis. Available at: http://www.who.int/malaria/areas/treatment/MoU_termination_report_may2011.pdf. [Google Scholar]
  4. Ubben D, Poll EM, , 2013. MMV in partnership: the Eurartesim® experience. Malar J 12: 211.[Crossref] [Google Scholar]
  5. Bassat Q, Mulenga M, Tinto H, Piola P, Borrmann S, Menendez C, Nambozi M, Valea I, Nabasumba C, Sasi P, Bacchieri A, Corsi M, Ubben D, Talisuna A, D'Alessandro U, , 2009. Dihydroartemisinin-piperaquine and artemether-lumefantrine for treating uncomplicated malaria in African children: a randomised, non-inferiority trial. PLoS One 4: e7871.[Crossref] [Google Scholar]
  6. The Four Artemisinin-Based Combinations Study Group, 2011. A head-to-head comparison of four artemisinin-based combinations for treating uncomplicated malaria in African children: a randomized trial. PLoS Med 8: e10011. [Google Scholar]
  7. Kamya MR, Yeka A, Bukirwa H, Lugemwa M, Rwakimari JB, Staedke SG, Talisuna AO, Greenhouse B, Nosten F, Rosenthal PJ, Wabwire-Mangen F, Dorsey G, , 2007. Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treatment of malaria: a randomized trial. PLoS Clin Trials 2: e20.[Crossref] [Google Scholar]
  8. Sawa P, Shekalaghe SA, Drakeley CJ, Sutherland CJ, Mweresa CK, Baidjoe AY, Manjurano A, Kavishe RA, Beshir KB, Yussuf RU, Omar SA, Hermsen CC, Okell L, Schallig HD, Sauerwein RW, Hallett RL, Bousema T, , 2013. Malaria transmission after artemether-lumefantrine and dihydroartemisinin-piperaquine: a randomized trial. J Infect Dis 207: 16371645.[Crossref] [Google Scholar]
  9. Yeka A, Dorsey G, Kamya MR, Talisuna A, Lugemwa M, Rwakimari JB, Staedke SG, Rosenthal PJ, Wabwire-Mangen F, Bukirwa H, , 2008. Artemether-lumefantrine versus dihydroartemisinin-piperaquine for treating uncomplicated malaria: a randomized trial to guide policy in Uganda. PLoS One 3: e2390.[Crossref] [Google Scholar]
  10. Yeka A, Tibenderana J, Achan J, D'Alessandro U, Talisuna AO, , 2013. Efficacy of quinine, artemether-lumefantrine and dihydroartemisinin-piperaquine as rescue treatment for uncomplicated malaria in Ugandan children. PLoS One 8: e53772.[Crossref] [Google Scholar]
  11. Price RN, Douglas NM, , 2009. Artemisinin combination therapy for malaria: beyond good efficacy. Clin Infect Dis 49: 16381640.[Crossref] [Google Scholar]
  12. Zani B, Gathu M, Donegan S, Olliaro PL, Sinclair D, , 2014. Dihydroartemisinin-piperaquine for treating uncomplicated Plasmodium falciparum malaria. Cochrane Database Syst Rev 1: CD010927. [Google Scholar]
  13. Pfeil J, Borrmann S, Tozan Y, , 2014. Dihydroartemisinin-piperaquine vs. artemether-lumefantrine for first-line treatment of uncomplicated malaria in African children: a cost-effectiveness analysis. PLoS One 9: e95681. [Google Scholar]
  14. Okell LC, Cairns M, Griffin JT, Ferguson NM, Tarning J, Jagoe G, Hugo P, Baker M, D'Alessandro U, Bousema T, Ubben D, Ghani AC, , 2014. Contrasting benefits of different artemisinin combination therapies as first-line malaria treatments using model-based cost-effectiveness analysis. Nat Commun 5: 5606.[Crossref] [Google Scholar]
  15. Lubell Y, Dondorp A, Guérin PJ, Drake T, Meek S, Ashley E, Day NPJ, White NJ, White LJ, , 2014. Artemisinin resistance—modelling the potential human and economic costs. Malar J 13: 452.[Crossref] [Google Scholar]
  16. Lubell Y, Riewpaiboon A, Dondorp AM, von Seidlein L, Mokuolu OA, Nansumba M, Gesase S, Kent A, Mtove G, Olaosebikan R, Ngum WP, Fanello CI, Hendriksen I, Day NP, White NJ, Yeung S, , 2011. Cost-effectiveness of parenteral artesunate for treating children with severe malaria in sub-Saharan Africa. Bull World Health Organ 89: 504512.[Crossref] [Google Scholar]
  17. Lopez ADAO, Guillot M, Inoue M, Ferguson BD, Salomon JA, , 2001. Life Tables for 191 Countries for 2000: Data, Methods, Results (GPE discussion paper no. 40). Health Systems Performance Assessment Peer Review. Technical documentation. IV Outcomes: Population Health. Geneva, Switzerland: World Health Organization. [Google Scholar]
  18. Murray C, Lopez A, , 1996. The Global Burden of Disease: A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries, and Risk Factors in 1990 and Projected to 2020, 1st edition. Cambridge, MA: Harvard School of Public Health (ISBN-13: 978-0674354487). [Google Scholar]
  19. Edejer TT, Baltussen R, Adam T, Hutubessy R, Acharya A, Evands DB, Murray CJL, , 2003. Making Choices in Health: WHO Guide to Cost-Effectiveness Analysis. Geneva, Switzerland: World Health Organization, 68 (ISBN 9241546018). [Google Scholar]
  20. The Global Fund, 2013. ACT Prices under the Affordable Medicines Facility-Malaria, Fact Sheet. Available at: http://www.theglobalfund.org/Documents/amfm/AMFm_ACTPrice_Factsheet_en/. [Google Scholar]
  21. Ayieko P, Akumu AO, Griffiths UK, English M, , 2009. The economic burden of inpatient paediatric care in Kenya: household and provider costs for treatment of pneumonia, malaria and meningitis. Cost Eff Resour Alloc 7: 3.[Crossref] [Google Scholar]
  22. Bureau of Labor Statistics, Consumer Price Index, CPI Inflation Calculator. Available at: http://www.bls.gov/cpi/. Accessed January 29, 2014.
  23. Goodman C, Mills A, , 2000. Economic Analysis of Malaria Control in Sub-Saharan Africa. Geneva, Switzerland: Global Forum for Health Research. [Google Scholar]
  24. Shillcutt S, Morel C, Goodman C, Coleman P, Bell D, Whitty CJ, Mills A, , 2008. Cost-effectiveness of malaria diagnostic methods in sub-Saharan Africa in an era of combination therapy. Bull World Health Organ 86: 101110.[Crossref] [Google Scholar]
  25. Mori AT, Ngalesoni F, Norheim OF, Robberstad B, , 2014. Cost-effectiveness of dihydroartemisinin-piperaquine compared with artemether-lumefantrine for treating uncomplicated malaria in children at a district hospital in Tanzania. Malar J 13: 363.[Crossref] [Google Scholar]
  26. Ewing VL, Terlouw A, Kapinda A, Pace C, Richards E, Tolhurst R, Lalloo D, , 2015. Perceptions and utilization of the anti-malarials artemether-lumefantrine and dihydroartemisinin-piperaquine in young children in the Chikhwawa District of Malawi: a mixed methods study. Malar J 14: 13.[Crossref] [Google Scholar]
  27. Arinaitwe E, Sandison TG, Wanzira H, Kakuru A, Homsy J, Kalamya J, Kamya MR, Vora N, Greenhouse B, Rosenthal PJ, Tappero J, Dorsey G, , 2009. Artemether-lumefantrine versus dihydroartemisinin-piperaquine for falciparum malaria: a longitudinal, randomized trial in young Ugandan children. Clin Infect Dis 49: 16291637.[Crossref] [Google Scholar]
  28. Boni MF, Smith DL, Laxminarayan R, , 2008. Benefits of using multiple first-line therapies against malaria. Proc Natl Acad Sci USA 105: 1421614221.[Crossref] [Google Scholar]

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  • Received : 25 Feb 2015
  • Accepted : 24 Jun 2015
  • Published online : 04 Nov 2015

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