ACT NOW OR LATER? ECONOMICS OF MALARIA RESISTANCE

RAMANAN LAXMINARAYAN Resources for the Future, Washington, District of Columbia

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In the past, malaria control efforts in sub-Saharan Africa have relied on a combination of vector control with effective treatment using chloroquine. With increasing resistance to chloroquine, attention has now turned to alternative treatment strategies to replace this failing drug. Some countries have already changed their official first-line treatment to sulfadoxine-pyrimethamine, while others are contemplating a switch to artemisinin-based combination treatments (ACTs). Although there are strong theoretical arguments in favor of switching to ACTs, the validity of these arguments in the face of financial constraints has not been previously analyzed. In this report, we use a bioeconomic model of malaria transmission and evolution of drug resistance to examine questions of optimal treatment strategy and coverage when drug resistance places an additional constraint on choices available to the policymaker.

  • 1

    Trape JF, 2001. The public health impact of chloroquine resistance in Africa. Am J Trop Med Hyg 64 :12–17.

  • 2

    Curtis CF, Otoo LN, 1986. A simple model of the build-up of resistance to mixtures of anti-malarial drugs. Trans R Soc Trop Med Hyg 80 :889–892.

    • Search Google Scholar
    • Export Citation
  • 3

    White NJ, 1999. Antimalarial drug resistance and combination chemotherapy. Philos Trans R Soc Lond B Biol Sci 354 :739–749.

  • 4

    White NJ, 1998. Preventing antimalarial drug resistance through combinations. Drug Res Updates 1 :3–9.

  • 5

    Hastings IM, D’Alessandro U, 2000. Modelling a predictable disaster: the rise and spread of drug-resistant malaria. Parasitol Today 16 :340–347.

    • Search Google Scholar
    • Export Citation
  • 6

    Winstanley PA, 2000. Chemotherapy for falciparum malaria: the armoury, the problems and the prospects. Parasitol Today 16 :146–153.

  • 7

    Bloland PB, Ettling M, Meek S, 2000. Combination therapy for malaria in Africa: hype or hope? Bull World Health Organ 78 :1378–1388.

  • 8

    Anderson RM, May RM, 1991. Infectious Diseases of Humans: Dynamics and Control. New York: Oxford University Press.

  • 9

    Koella JC, 1991. On the use of mathematical models of malaria transmission. Acta Trop 49 :1–25.

  • 10

    Aron JL, 1988. Acquired immunity dependent upon exposure in an SIRS epidemic model. Math Biosci 88 :37–47.

  • 11

    Aron JL, 1988. Mathematical modelling of immunity of malaria. Math Biosci 90 :385–396.

  • 12

    Koella JC, Antia R, 2003. Epidemiological models for the spread of anti-malarial resistance. Malar J 2 :3.

  • 13

    Mackinnon MJ, 1997. Survival probability of drug resistant mutants in malaria parasites. Proc R Soc Lond B Biol Sci 264 :53–59.

  • 14

    Mackinnon MJ, Hastings IM, 1998. The evolution of multiple drug resistance in malaria parasites. Trans R Soc Trop Med Hyge 92 :188–195.

    • Search Google Scholar
    • Export Citation
  • 15

    Koella JC, 1998. Costs and benefits of resistance against antimalarial drugs. Parasitol Today 14 :360–364.

  • 16

    Lines JD, Wilkes TJ, Lyimo EO, 1991. Human malaria infectiousness measured by age-specific sporozoite rates in Anopheles gambiae in Tanzania. Parasitology 102 :167–177.

    • Search Google Scholar
    • Export Citation
  • 17

    Pringle G, Avery-Jones S, 1966. Observations on the early course of untreated falciparum malaria in semi-immune African children following a short period of protection. Bull World Health Organ 34 :269–272.

    • Search Google Scholar
    • Export Citation
  • 18

    Cornille-Brogger R, Mathews HM, Storey J, Ashkar TS, Brogger S, Molineaux L, 1978. Changing patterns in the humoral immune response to malaria before, during, and after the application of control measures: a longitudinal study in the West African savanna. Bull World Health Organ 56 :579–600.

    • Search Google Scholar
    • Export Citation
  • 19

    MacDonald G, 1957. The Epidemiology and Control of Malaria. London and New York: Oxford University Press.

  • 20

    Chima RI, Goodman CA, Mills A, 2003. The economic impact of malaria in Africa: a critical review of the evidence. Health Policy 63 :17–36.

    • Search Google Scholar
    • Export Citation
  • 21

    Ettling MB, Shepard DS, 1991. Economic cost of malaria in Rwanda. Trop Med Parasitol 42 :214–218.

  • 22

    Ettling MB, Thimasarn K, Shepard DS, Krachaiklin S, 1991. Economic analysis of several types of malaria clinics in Thailand. Bull World Health Organ 69 :467–476.

    • Search Google Scholar
    • Export Citation
  • 23

    Ettling M, McFarland DA, Schultz LJ, Chitsulo L, 1994. Economic impact of malaria in Malawian households. Trop Med Parasitol 45 :74–79.

    • Search Google Scholar
    • Export Citation
  • 24

    Sauerborn R, Shepard DS, Ettling MB, Brinkmann U, Nougtara A, Diesfeld HJ, 1991. Estimating the direct and indirect economic costs of malaria in a rural district of Burkina Faso. Trop Med Parasitol 42 :219–223.

    • Search Google Scholar
    • Export Citation
  • 25

    Gomes M, 1993. Economic and demographic research on malaria: a review of the evidence. Soc Sci Med 37 :1093–1108.

  • 26

    Asenso-Okyere WK, Dzator JA, 1997. Household cost of seeking malaria care: A retrospective study of two districts in Ghana. Soc Sci Med 45 :659–667.

    • Search Google Scholar
    • Export Citation
  • 27

    Shepard DS, Ettling MB, Brinkmann U, Sauerborn R, 1991. The economic cost of malaria in Africa. Trop Med Parasitol 42 :199–203.

  • 28

    Snow RW, Eckert E, Teklehaimanot A, 2003. Estimating the needs for artesunate-based combination therapy for malaria-case management in Africa. Trends Parasitol 19 :363–369.

    • Search Google Scholar
    • Export Citation
  • 29

    Molineaux L, Gramiccia G, 1980. The Garki Project: Research on the Epidemiology and Control of Malaria in the Sudan Savanna of West Africa. Geneva: World Health Organization.

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