1921
Volume 103, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

The recent Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance (MORDOR) trial reported a reduction in child mortality following biannual azithromycin mass drug administration (MDA). Here, we investigate the financial costs and cost-effectiveness from the health provider perspective of azithromycin MDA at the MORDOR-Malawi study site. During MORDOR, a cluster-randomized trial involving biannual azithromycin MDA or placebo to children aged 1–59 months, fieldwork-related costs were collected, including personnel, transport, consumables, overheads, training, and supervision. Mortality rates in azithromycin- and placebo-treated clusters were calculated overall and for the five health zones of Mangochi district. These were used to estimate the number needed to treat to avert one death and the costs per death and disability-adjusted life year (DALY) averted. The cost per dose of MDA was $0.74 overall, varying between $0.63 and $0.94 in the five zones. Overall, the number needed to treat to avert one death was 1,213 children; the cost per death averted was $898.47, and the cost per DALY averted was $9.98. In the three zones where mortality was lower in azithromycin-treated clusters, the number needed to treat to avert one death, cost per death averted, and cost per DALY averted, respectively, were as follows: 3,070, $2,899.24, and $32.31 in Monkey Bay zone; 1,530, $1,214.42, and $13.49 in Chilipa zone; and 344, $217.98, and $2.42 in Namwera zone. This study is a preliminary cost-effectiveness analysis that indicates azithromycin MDA for reducing child mortality has the potential to be highly cost-effective in some settings in Malawi, but the reasons for geographical variation in effectiveness require further investigation.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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References

  1. World Health Organization, 2017. Report of the 19th meeting of the WHO Alliance for the Global Elimination of Trachoma by 2020. Hammamet, Tunisia: WHO/Department of Control of Neglected Tropical Diseases.
  2. Coles CL, Seidman JC, Levens J, Mkocha H, Munoz B, West S, 2011. Association of mass treatment with azithromycin in trachoma-endemic communities with short-term reduced risk of diarrhea in young children. Am J Trop Med Hyg 85: 691696.
    [Google Scholar]
  3. Kigen G, Rotich J, Karimurio J, Rono H, 2014. Collateral benefits arising from mass administration of azithromycin in the control of active trachoma in resource limited settings. Pan Afr Med J 19: 256.
    [Google Scholar]
  4. Schachterle SE, Mtove G, Levens JP, Clemens E, Shi L, Raj A, Dumler JS, Munoz B, West S, Sullivan DJ, 2014. Short-term malaria reduction by single-dose azithromycin during mass drug administration for trachoma, Tanzania. Emerg Infect Dis 20: 941949.
    [Google Scholar]
  5. Sadiq ST, Glasgow KW, Drakeley CJ, Muller O, Greenwood BM, Mabey DC, Bailey RL, 1995. Effects of azithromycin on malariometric indices in the Gambia. Lancet 346: 881882.
    [Google Scholar]
  6. Whitty CJ, Glasgow KW, Sadiq ST, Mabey DC, Bailey R, 1999. Impact of community-based mass treatment for trachoma with oral azithromycin on general morbidity in Gambian children. Pediatr Infect Dis J 18: 955958.
    [Google Scholar]
  7. Porco TC et al., 2009. Effect of mass distribution of azithromycin for trachoma control on overall mortality in Ethiopian children: a randomized trial. JAMA 302: 962968.
    [Google Scholar]
  8. Keenan JD et al., MORDOR Study Group, 2018. Azithromycin to reduce childhood mortality in sub-Saharan Africa. N Engl J Med 378: 15831592.
    [Google Scholar]
  9. The United Nations Inter-Agency Group for Child Mortality Estimation. Levels and Trends in Child Mortality Report, 2017.
  10. National Statistical Office and ICF Macro, 2011. Malawi Demographic and Health Survey 2010. Zomba, Malawi, and Calverton, MD.
    [Google Scholar]
  11. WHO, 2013. WHO Methods and Data Sources for Global Burden of Disease Estimates 2000–2011. Geneva, Switzerland: World Health Organization.
    [Google Scholar]
  12. Murray CJ et al., 2012. GBD 2010: design, definitions, and metrics. Lancet 380: 20632066.
    [Google Scholar]
  13. Porco TC et al., Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance (MORDOR) Study Group, 2019. Mass oral azithromycin for childhood mortality: timing of death after distribution in the MORDOR trial. Clin Infect Dis 68: 21142116.
    [Google Scholar]
  14. Marseille E, Larson B, Kazi DS, Kahn JG, Rosen S, 2015. Thresholds for the cost–effectiveness of interventions: alternative approaches. Bull World Health Organ 93: 118124.
    [Google Scholar]
  15. World Bank, 2016. GDP Per Capita. Washington, DC: The World Bank Group. Available at: https://data.worldbank.org/indicator/NY.GDP.PCAP.CD?end=2016. Accessed November 11, 2019.
    [Google Scholar]
  16. Management Sciences for Health, 2016. International Medical Products Price Guide, 2015 edition. Medford, MA: MSH.
    [Google Scholar]
  17. Prinja S, Bahuguna P, Mohan P, Mazumder S, Taneja S, Bhandari N, van den Hombergh H, Kumar R, 2016. Cost effectiveness of implementing integrated management of neonatal and childhood illnesses program in district Faridabad, India. PLoS One 11: e0145043.
    [Google Scholar]
  18. Nonvignon J, Aryeetey GC, Issah S, Ansah P, Malm KL, Ofosu W, Tagoe T, Agyemang SA, Aikins M, 2016. Cost-effectiveness of seasonal malaria chemoprevention in upper west region of Ghana. Malar J 15: 367.
    [Google Scholar]
  19. Brady MA, Hooper PJ, Ottesen EA, 2006. Projected benefits from integrating NTD programs in sub-Saharan Africa. Trends Parasitol 22: 285291.
    [Google Scholar]
  20. Fenwick A, Molyneux D, Nantulya V, 2005. Achieving the millennium development Goals. Lancet 365: 10291030.
    [Google Scholar]
  21. Harding-Esch E et al., 2015. Costs of testing for ocular Chlamydia trachomatis infection compared to mass drug administration for trachoma in the Gambia: application of results from the PRET study. PLoS Negl Trop Dis 9: e0003670.
    [Google Scholar]
  22. Kolaczinski JH, Robinson E, Finn TP, 2011. The cost of antibiotic mass drug administration for trachoma control in a remote area of South Sudan. PLoS Negl Trop Dis 5: e1362.
    [Google Scholar]
  23. Rumunu J, Brooker S, Hopkins A, Chane F, Emerson P, Kolaczinski J, 2009. Southern Sudan: an opportunity for NTD control and elimination? Trends Parasitol 25: 301307.
    [Google Scholar]
  24. Gedge LM, Bettis AA, Bradley MH, Hollingsworth TD, Turner HC, 2018. Economic evaluations of lymphatic filariasis interventions: a systematic review and research needs. Parasite Vectors 11: 75.
    [Google Scholar]
  25. Tan-Torres Edejer T, Baltussen R, Adam T, Hutubessy R, Acharya A, Evans DB, Murray CJL, 2003. Making Choices in Health: WHO Guide to Cost-Effectiveness Analysis. Geneva, Switzerland: World Health Organization.
    [Google Scholar]
  26. Gaynor BD, Holbrook KA, Whitcher JP, Holm SO, Jha HC, Chaudhary JS, Bhatta RC, Lietman T, 2003. Community treatment with azithromycin for trachoma is not associated with antibiotic resistance in Streptococcus pneumoniae at 1 year. Br J Ophthalmol 87: 147148.
    [Google Scholar]
  27. Batt SL, Charalambous BM, Solomon AW, Knirsch C, Massae PA, Safari S, Sam NE, Everett D, Mabey DC, Gillespie SH, 2003. Impact of azithromycin administration for trachoma control on the carriage of antibiotic-resistant Streptococcus pneumoniae. Antimicrob Agents Chemother 47: 27652769.
    [Google Scholar]
  28. Haug S et al., 2010. The decline of pneumococcal resistance after cessation of mass antibiotic distributions for trachoma. Clin Infect Dis 51: 571574.
    [Google Scholar]
  29. Doan T; MORDOR Study Group, 2019. Macrolide resistance in MORDOR I—a cluster-randomized trial in Niger. N Engl J Med 380: 22712273.
    [Google Scholar]
  30. Keenan JD et al., 2019. Longer-term assessment of azithromycin for reducing childhood mortality in Africa. N Engl J Med 380: 22072214.
    [Google Scholar]
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  • Received : 22 Aug 2019
  • Accepted : 23 Jan 2020
  • Published online : 27 Apr 2020
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