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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
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
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.