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An Economic Evaluation of the Posttreatment Prophylactic Effect of Dihydroartemisinin–Piperaquine Versus Artemether–Lumefantrine for First-Line Treatment of Plasmodium falciparum Malaria Across Different Transmission Settings in Africa

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  • Parasitology Unit, Department for Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany; General Pediatrics Unit, Center for Childhood and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; German Centre for Infectious Diseases (DZIF), University of Tübingen, Tübingen, Germany; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Tropical Diseases Research Centre, Ndola, Zambia; Department of Public Health Research, University of Oxford-KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Steinhardt School of Culture, Education and Human Development, New York University, New York, New York; College of Global Public Health, New York University, New York, New York; Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany

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.

Author Notes

* Address correspondence to Yesim Tozan, College of Global Public Health, New York University, 411 Lafayette Street, 5th Floor, New York, NY 10012. E-mail: tozan@nyu.edu

Authors' addresses: Johannes Pfeil, Parasitology Unit, Department for Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany, and General Pediatrics Unit, Center for Childhood and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany, E-mail: johannes.pfeil@med.uni-heidelberg.de. Steffen Borrmann, Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany, E-mail: sborrmann@me.com. Quique Bassat, ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain, E-mail: quique.bassat@isglobal.org. Modest Mulenga, Tropical Diseases Research Centre, Ndola, Zambia, E-mail: mulengam@tdrc.org.zm. Ambrose Talisuna, Department of Public Health Research, University of Oxford-KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya, E-mail: atalisuna@kemri-wellcome.org. Yesim Tozan, College of Global Public Health, New York University, New York, NY, E-mail: tozan@nyu.edu.

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