Volume 77, Issue 3
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


This study is a cost-benefits analysis of the recommendations of the Centers for Disease Control and Prevention for presumptive anti-malarial treatment among departing West African refugees. We conducted a retrospective chart review of symptomatic, blood smear–positive cases of malaria seen in Minneapolis, Minnesota, from 1996 through 2005. Billing charges of U.S. care were compared with estimates of implementation costs for overseas treatment. Fifty-eight symptomatic malaria infections occurred among West African refugees. After overseas pre-departure presumptive treatment, symptomatic malaria in arriving refugees decreased from 8.2% to 0%. The pre-departure number needed to treat to prevent one case of symptomatic malaria is 13.9 (95% confidence interval = 9.8–24). The average U.S. billing charge for each malaria case is $1,730. Overseas implementation costs for presumptive treatment are estimated to be between $141 and $346 to prevent one U.S. malaria case. Overseas presumptive pre-departure anti-malarial therapy prevents clinical malaria in refugees and results in cost-benefits when the malaria prevalence is > 1%. Overseas presumptive therapy has greater cost-benefits than U.S. based screening and treatment strategies.


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  1. Breman JG, Alilio MS, Mills A, 2004. Conquering the intolerable burden of malaria: what’s new, what’s needed: a summary. Am J Trop Med Hyg 71 : 1–15. [Google Scholar]
  2. Skarbinski J, James EM, Causer LM, Barber AM, Mali S, Nguyen-Dinh P, Roberts JM, Parise ME, Slutsker L, Newman RD, 2006. Malaria surveillance–United States, 2004. MMWR Surveill Summ 55 : 23–37. [Google Scholar]
  3. Eliades MJ, Shah S, Nguyen-Dinh P, Newman RD, Barber AM, Nguyen-Dinh P, Roberts JM, Mali S, Parise ME, Barber AM, Steketee R, 2005. Malaria surveillance–United States, 2003. MMWR Surveill Summ 54 : 25–39. [Google Scholar]
  4. Maroushek SR, Aguilar EF, Stauffer W, Abd-Alla MD, 2005. Malaria among refugee children at arrival in the United States. Pediatr Infect Dis J 24 : 450–452. [Google Scholar]
  5. Daggy RH, Muegge OJ, Riley WA, 1998. A preliminary survey of the anopheline mosquito fauna of southeastern Minnesota and adjacent Wisconsin areas. Minn Med 81 : 41–44. [Google Scholar]
  6. Zucker J, 1996. Changing patterns of autochthonous malaria transmission in the United States: a review of recent outbreaks. Emerg Infect Dis 2 : 37–43. [Google Scholar]
  7. Centers for Disease Control and Prevention, Filler SJ, Mac-Arthur JR, Parise M, Wirtz R, Eliades MJ, Dasilva A, Steketee R, 2006. Locally acquired mosquito-transmitted malaria: a guide for investigations in the United States epidemiological investigation. MMWR Morb Mortal Wkly Rep 55 : 1–9. [Google Scholar]
  8. Newcombe RG, 1998. Interval estimation for the difference between independent proportions: comparison of eleven methods. Stat Med 17 : 873–890. [Google Scholar]
  9. Minnesota Department of Health. Refugee Health Statistics. Accessed October 24, 2006. Available from http://www.health.state.mn.us/divs/idepc/refugee/stats/index.html
  10. Seys SA, Bender JB, 2001. The changing epidemiology of malaria in Minnesota. Emerg Infect Dis 7 : 993–995. [Google Scholar]
  11. International Organization for Migration, Migrant Health Department, United States Refugee Program, Medical Program for Sub-Saharan Africa. Pre-Departure Anti-Malarial and Anti-Intestinal Parasitosis Treatment Report. October 1, 2003–September 30, 2004, Fiscal Year 2004 Report, and October 1, 2001–June 2002, Fiscal Year 2002 Report.
  12. Centers for Medicare and Medicaid Services. 100% MEDPAR Inpatient Hospital National Data for Fiscal Year 2005. Accessed March 7, 2007. Available from http://www.cms.hhs.gov/MedicareFeeforSvcPartsAB/03_MEDPAR.asp
  13. Collins WE, Jeffery GM, 2002. A retrospective examination of sporozoite-induced and trophozoite-induced infections with Plasmodium ovale: development of parasitologic and clinical immunity during primary infection. Am J Trop Med Hyg 66 : 492–502. [Google Scholar]
  14. World Health Organization. Procurement of Artemether-Lumefantrine (Coartem ® ) through WHO. Accessed November 6, 2006. Available from http://www.emro.who.int/rbm/background%20documents/egy04/CoA.pdf
  15. Arrow KJ, Gelband H, Jamison DT, 2005. Making antimalarial agents available in Africa. N Engl J Med 352 : 333–335. [Google Scholar]
  16. Arrow KJ, Panosian C, Gelband H, 2004. Saving Lives, Buying Time: Economics of Malaria Drugs in an Age of Resistance. Washington, DC: National Academies Press.
  17. Pan American Health Organization. Access to Antimalarial Medicines: Improving the Affordability and Financing of Artemisinin-Based Combination Therapies. Accessed October 24, 2006. Available from http://www.paho.org/English/AD/DPC/CD/mal-afford.htm
  18. Wiseman V, Kim M, Mutabingwa T, Whitty CJ, 2006. Cost-effectiveness study of three antimalarial drug combinations in Tanzania. PLoS Med 3 : e373. [Google Scholar]
  19. Chanda P, Masiye F, Chitah B, Sipilanyambe N, Hawela M, Banda P, Okorosobo T, 2007. A cost-effectiveness analysis of artemether lumefantrine for treatment of uncomplicated malaria in Zambia. Malar J 6 : 21. [Google Scholar]
  20. World Health Organization, 2003: Assessment and Monitoring of Antimalarial Drug Efficacy for the Treatment of Uncomplicated falciparum Malaria. Geneva: World Health Organization.
  21. Piola P, Fogg C, Bajunirwe F, Biraro S, Grabdesso F, Ruzagira E, BAbigumira J, Kigozi I, Kiguli J, Kyomuhendo J, Ferradini L, Taylor W, Checchi F, Guthmann JP, 2005. Supervised versus unsupervised intake of six-dose artemether-lumefantrine for treatment of acute, uncomplicated Plasmodium falciparum malaria in Mbarara, Uganda: a randomised trial. Lancet 365 : 1467–1473. [Google Scholar]
  22. Chanda P, Hawela M, Kango M, Sipilanyambe N, 2006. Assessment of the therapeutic efficacy of a paediatric formulation of artemether-lumefantrine (Coartesiane) for the treatment of uncomplicated Plasmodium falciparum in children in Zambia. Malar J 5 : 75. [Google Scholar]
  23. Bukirwa H, Yeka A, Kamya MR, Talisuna A, Banek K, Bakyaita N, Rwakimari JB, Rosenthal PJ, Wabwire-Mangen F, Dorsey G, Staedke SG, 2006. Artemisinin combination therapies for treatment of uncomplicated malaria in Uganda. PLoS Clin Trials 1 : e7. [Google Scholar]
  24. Jima D, Tesfaye G, Medhin A, Kebede A, Argaw D, Babaniyi O, 2005. Safety and efficacy of artemether-lumefantrine in the treatment of uncomplicated falciparum malaria in Ethiopia. East Afr Med J 82 : 387–390. [Google Scholar]
  25. Mutabingwa TK, Anthony D, Heller A, Hallett R, Ahmed J, Drakeley C, Greenwood BM, Whitty CJ, 2005. Amodiaquine alone, amodiaquine + sulfadoxine-pyrimethamine, amodiaquine + artesunate, and artemether-lumefantrine for outpatient treatment of malaria in Tanzanian children: a four arm randomized effectiveness trial. Lancet 365 : 1474–1480. [Google Scholar]
  26. White NJ, 2003. Malaria. Cook GC, Zumla AL, eds. Manson’s Tropical Diseases. 21st edition. London: W. B. Saunders, 1206–1210.
  27. Stauffer WM, Newberry AM, Cartwright CP, Rosenblatt JE, Hanson K, Sloan L, Tsukayama D, Taylor C, Juni B, 2006. Evaluation of malaria screening in newly arrived refugees to the United States by microscopy and rapid antigen capture enzyme assay (Binax-Now™). Pediatr Infect Dis J 25 : 948–950. [Google Scholar]
  28. Kain KC, Harrington MA, Tennyson S, Keystone JS, 1998. Imported malaria: prospective analysis of problems in diagnosis and management. Clin Infect Dis 27 : 142–149. [Google Scholar]
  29. Office of Refugee Resettlement Annual Reports to Congress 1997–2004. Accessed December 11, 2006. Available from http://www.acf.hhs.gov/programs/orr/policy
  30. Holtz TH, Kachur SP, MacArthur JR, Roberts JM, Barber AM, Steketee RW, Parise ME, 2001. Malaria surveillance–United States, 1998. MMWR CDC Surveill Summ 50 : 1–20. [Google Scholar]

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  • Received : 13 Feb 2007
  • Accepted : 06 Jun 2007

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