Review

Malaria treatment and prophylaxis in endemic and nonendemic countries: evidence on strategies and their cost–effectiveness

Infectious Diseases, Center for Tropical Medicine & Travel Medicine, Division of Internal Medicine, AIGHD, Academic Medical Center, University of Amsterdam, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, The Netherlands

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Anne van Beest

Department of economics, VU University Medical Center, Amsterdam, The Netherlands

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Elisa Sicuri

Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain

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Maurits van Tulder

Department of economics, VU University Medical Center, Amsterdam, The Netherlands

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Martin P Grobusch

* Author for correspondence

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Email the corresponding author at m.p.grobusch@amc.uva.nl

Published Online:28 Nov 2011https://doi.org/10.2217/fmb.11.138

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Abstract

Artemisinin combination treatment is currently the preferred treatment strategy to combat malaria. However, the drug costs are considerably higher than for previously used therapies. This review discusses the cost–effectiveness of current malaria treatment and prophylaxis in endemic and nonendemic countries. For endemic countries, a systematic search for economic evaluations (i.e., cost–effectiveness, cost–utility and cost–benefit analyses) was conducted, looking at the use of Artemisinin combination treatments in children, pregnant women and other adults. In total, 24 studies were identified investigating the cost–effectiveness of malaria treatments with the focus on uncomplicated malaria, severe or prereferral treatment, all in combination with adequate diagnosis, and malaria prevention by intermittent preventive treatment, respectively. In areas with both Plasmodium falciparum and Plasmodium vivax transmission, artemether–lumefantrine and dihydroartemisinin–piperaquine, respectively, are currently the most cost-effective treatment options. Treatment of severe malaria with artesunate is more cost effective compared with treatment with quinine. For patients that live more than 6 h away from an appropriate healthcare facility, prereferral treatment proved to be more cost-effective compared with no prereferral intervention. Cost–effectiveness of intermittent preventive treatment in pregnant women (IPTp) was dependent an clinical attendance. IPT in infants with sulphadoxine–pyrimethamine (SP) is cost effective in sites with high malaria transmission. IPT in children with artesunate (AS + SP), amodiaquine (AQ) + SPQ or SP alone is a cost effective and safe intervention for reducing the burden of malaria in children in areas with markedly seasonal malaria transmission. Although there is a need for it, little is known about the cost–effectiveness of current approaches to malaria therapy in nonendemic countries and the cost–effectiveness of antimalarial chemoprophylaxis.

Keywords:

Papers of special note have been highlighted as: ▪ of interest ▪▪ of considerable interest

References

1 Davis WA, Clarke PM, Siba PM et al. Cost–effectiveness of artemisinin combination therapy for uncomplicated malaria in children: data from Papua New Guinea. Bull. World Health Organ.89(3),211–220 (2011).Crossref, Medline, Google Scholar
2 Buchanan J, Mihaylova B, Gray A, White N. Cost–effectiveness of pre-referral antimalarial, antibacterial, and combined rectal formulations for severe febrile illness. PLoS ONE5(12),e14446 (2010).Crossref, Medline, CAS, Google Scholar
3 Grobusch MP, Kremsner PG. Uncomplicated malaria. Curr. Trop. Microbiol. Immunol.295,83–104 (2005).Medline, CAS, Google Scholar
4 Sinclair D, Zani B, Donegan S, Olliaro P, Garner P. Artemisinin-based combination therapy for treating uncomplicated malaria. Cochrane Database Syst. Rev.3,CD007483 (2009).Google Scholar
5 Chanda P, Castillo-Riquelme M, Masiye F. Cost–effectiveness analysis of the available strategies for diagnosing malaria in outpatient clinics in Zambia. Cost Eff. Resour. Alloc.7,5 (2009).Crossref, Medline, Google Scholar
6 Rolland E, Checchi F, Pinoges L, Balkan S, Guthmann JP, Guerin PJ. Operational response to malaria epidemics: are rapid diagnostic tests cost-effective? Trop. Med. Int. Health11(4),398–408 (2006).Crossref, Medline, Google Scholar
7 Ly AB, Tall A, Perry R et al. Use of HRP-2-based rapid diagnostic test for Plasmodium falciparum malaria: assessing accuracy and cost–effectiveness in the villages of Dielmo and Ndiop, Senegal. Malar. J.9,153 (2010).Crossref, Medline, Google Scholar
8 Gallup JL, Sachs JD. The economic burden of malaria. Am. J. Trop. Med. Hyg.64(Suppl. 1–2),85–96 (2001).Crossref, Medline, CAS, Google Scholar
9 Sachs J, Malaney P. The economic and social burden of malaria. Nature415(6872),680–685 (2002).Crossref, Medline, CAS, Google Scholar
10 Chanda P, Masiye F, Chitah BM et al. A cost–effectiveness analysis of artemether lumefantrine for treatment of uncomplicated malaria in Zambia. Malar. J.6,21 (2007).Crossref, Medline, Google Scholar
11 Price R, Nosten F, Simpson JA et al. Risk factors for gametocyte carriage in uncomplicated falciparum malaria. Am. J. Trop. Med. Hyg.60(6),1019–1023 (1999).Crossref, Medline, CAS, Google Scholar
12 Targett G, Drakeley C, Jawara M et al. Artesunate reduces but does not prevent posttreatment transmission of Plasmodium falciparum to Anopheles gambiae. J. Infect. Dis.183(8),1254–1259 (2001).Crossref, Medline, CAS, Google Scholar
13 Giha HA. Artemisinin derivatives for treatment of uncomplicated Plasmodium falciparum malaria in Sudan: too early for too much hope. Parasitol. Res.106(3),549–552 (2010).Crossref, Medline, Google Scholar
14 Lubell Y, Reyburn H, Mbakilwa H et al. The Cost–effectiveness of parasitologic diagnosis for malaria-suspected patients in an era of combination therapy. Am. J. Trop. Med. Hyg.77(Suppl. 6),128–132 (2007).Crossref, Medline, Google Scholar
15 Dondorp AM, Fanello CI, Hendriksen IC et al. Artesunate versus quinine in the treatment of severe falciparum malaria in African children (AQUAMAT): an open-label, randomised trial. Lancet 13, 376(9753),1647–1657 (2010).▪▪ This study demonstrated the superiority of artesunate compared with quinine in the treatment of severe malaria in addition to perfoming cost analysis.Crossref, Medline, CAS, Google Scholar
16 Jones KL, Donegan S, Lalloo DG. Artesunate versus quinine for treating severe malaria. Cochrane Database Syst. Rev.4,CD005967 (2007).Google Scholar
17 Lubell Y, Yeung S, Dondorp AM et al. Cost–effectiveness of artesunate for the treatment of Severe malaria. Trop. Med. Int. Health14(3),332–337 (2009).▪▪ This study demonstrated the superiority of artesunate compared with quinine in the treatment of severe malaria in addition to perfoming cost analysis.Crossref, Medline, CAS, Google Scholar
18 Gomes MF, Faiz MA, Gyapong JO et al. Pre-referral rectal artesunate to prevent death and disability in severe malaria: a placebo-controlled trial. Lancet. 14, 373(9663),557–566 (2009).Crossref, Medline, CAS, Google Scholar
19 Tozan Y, Klein EY, Darley S, Panicker R, Laxminarayan R, Breman JG. Prereferral rectal artesunate for treatment of severe childhood malaria: a cost–effectiveness analysis. Lancet 4, 376(9756),1910–1915 (2010).▪▪ This study demonstrated the superiority of artesunate compared with quinine in treatment of severe malaria in addition to perfoming cost analysis.Crossref, Medline, CAS, Google Scholar
20 Grobusch MP. Early rectal artesunate administration: a life-saver in remote areas? Future Microbiol.4(4),397–400 (2009).Link, CAS, Google Scholar
21 Conteh L, Sicuri E, Manzi F et al. The cost–effectiveness of intermittent preventive treatment for malaria in infants in sub-Saharan Africa. PLoS ONE5(6),e10313 (2010).Crossref, Medline, Google Scholar
22 Hutton G, Schellenberg D, Tediosi F et al. Cost–effectiveness of malaria intermittent preventive treatment in infants (IPTi) in Mozambique and the United Republic of Tanzania. Bull. World Health Organ.87(2),123–129 (2009).Crossref, Medline, Google Scholar
23 Conteh L, Patouillard E, Kweku M, Legood R, Greenwood B, Chandramohan D. Cost effectiveness of seasonal intermittent preventive treatment using amodiaquine & artesunate or sulphadoxine-pyrimethamine in Ghanaian children. PLoS ONE5(8),e12223 (2010).Crossref, Medline, Google Scholar
24 Wilson AL; IPTc Taskforce. A systematic review and meta-analysis of the efficacy and safety of intermittent preventive treatment of malaria in children (IPTc). PLoS ONE6(2),e16976 (2011).Crossref, Medline, CAS, Google Scholar
25 Bojang KA, Akor F, Conteh L et al. Two strategies for the delivery of IPTc in an area of seasonal malaria transmission in the Gambia: a randomised controlled trial. PLoS Med.8(2),e1000409 (2011).Crossref, Medline, Google Scholar
26 Lubell Y, Mills AJ, Whitty CJ, Staedke SG. An economic evaluation of home management of malaria in Uganda: an interactive Markov model. PLoS ONE5(8),e12439 (2010).Crossref, Medline, Google Scholar
27 Rodriguez AJ, Ferrer MV, Barrera MA, Pacheco M, Daza V, Franco-Paredes C. Imported cases of malaria admitted to two hospitals of Margarita Island, Venezuela, 1998–2005. Travel Med. Infect. Dis.7(1),44–48 (2009).Crossref, Medline, Google Scholar
28 Zoller T, Naucke TJ, May J et al. Malaria transmission in non-endemic areas: case report, review of the literature and implications for public health management. Malar. J.8,71 (2009).Crossref, Medline, Google Scholar
29 Evers S, Goossens M, de Vet H, van Tulder M, Ament A. Criteria list for assessment of methodological quality of economic evaluations: Consensus on Health Economic Criteria. Int. J. Technol. Assess. Health. Care21(2),240–245 (2005).Crossref, Medline, Google Scholar
30 Shillcutt S, Morel C, Goodman C et al. Cost–effectiveness of malaria diagnostic methods in sub-Saharan Africa in an era of combination therapy. Bull. World Health Organ.86(2),101–110 (2008).Crossref, Medline, Google Scholar
31 Sicuri E, Bardaji A, Nhampossa T et al. Cost–effectiveness of intermittent preventive treatment of malaria in pregnancy in southern Mozambique. PLoS ONE5(10),e13407 (2010).Crossref, Medline, Google Scholar
32 Jamison DT, Breman JG, Measham AR et al.Disease Control Priorities in Developing Countries. Oxford University Press, Oxford, UK (1993).Google Scholar
33 Mosha JF, Conteh L, Tediosi F et al. Cost implications of improving malaria diagnosis: findings from north-eastern Tanzania. PLoS ONE5(1),e8707 (2010).▪ Accurate diagnosis and its costs are very important.Crossref, Medline, Google Scholar
34 Lubell Y, Reyburn H, Mbakilwa H et al. The impact of response to the results of diagnostic tests for malaria: cost-benefit analysis. BMJ336(7637),202–205 (2008).▪ Accurate diagnosis and its costs are very important.Crossref, Medline, Google Scholar
35 Lubell Y, Hopkins H, Whitty CJ, Staedke SG, Mills A. An interactive model for the assessment of the economic costs and benefits of different rapid diagnostic tests for malaria. Malar. J.7,21 (2008).Crossref, Medline, Google Scholar
36 Zikusooka CM, McIntyre D, Barnes KI. Should countries implementing an artemisinin-based combination malaria treatment policy also introduce rapid diagnostic tests? Malar. J.7,176 (2008).Crossref, Medline, Google Scholar
37 Uzochukwu BS, Obikeze EN, Onwujekwe OE, Onoka CA, Griffiths UK. Cost–effectiveness analysis of rapid diagnostic test, microscopy and syndromic approach in the diagnosis of malaria in Nigeria: implications for scaling-up deployment of ACT. Malar. J.8,265 (2009).Crossref, Medline, Google Scholar
38 Wiseman V, Kim M, Mutabingwa TK, Whitty CJ. Cost–effectiveness study of three antimalarial drug combinations in Tanzania. PLoS Med.3(10),e373 (2006).▪▪ For future studies we aim for a consistent approach and this study has taken that into account, for example for both providers and social costs.Crossref, Medline, Google Scholar
39 Coleman PG, Morel C, Shillcutt S, Goodman C, Mills AJ. A threshold analysis of the cost–effectiveness of artemisinin-based combination therapies in sub-saharan Africa. Am. J. Trop. Med. Hyg.71(Suppl. 2),196–204 (2004).Crossref, Medline, Google Scholar
40 de Oliveira MR, de Castro GA, Toscano CM. Cost effectiveness of OptiMal(R) rapid diagnostic test for malaria in remote areas of the Amazon Region, Brazil. Malar. J.9,277 (2010).Crossref, Medline, Google Scholar
41 Rosas Aguirre AM, Llanos Zavalaga LF, Trelles de BM. Cost–effectiveness ratio of using rapid tests for malaria diagnosis in the Peruvian Amazon. Rev. Panam. Salud. Publica.25(5),377–388 (2009).Crossref, Medline, Google Scholar
42 Lemma H, San SM, Lofgren C, Barnabas G. Cost–effectiveness of three malaria treatment strategies in rural Tigray, Ethiopia where both Plasmodium falciparum and Plasmodium vivax co-dominate. Cost Eff. Resour. Alloc.9,2 (2011).Crossref, Medline, Google Scholar
43 Lubell Y, Riewpaiboon A, Dondorp AM, et al.Cost-effectiveness of parenteral artesunate for treating children with severe malaria in sub-Saharan Africa. Bull. World Health Organ.89(7),504–512. (2011)Crossref, Medline, Google Scholar
44 Mbonye AK, Hansen KS, Bygbjerg IC, Magnussen P. Intermittent preventive treatment of malaria in pregnancy: the incremental cost–effectiveness of a new delivery system in Uganda. Trans. R. Soc. Trop. Med. Hyg.102(7),685–693 (2008).Crossref, Medline, CAS, Google Scholar
45 Temperley M, Mueller DH, Njagi JK et al. Costs and cost–effectiveness of delivering intermittent preventive treatment through schools in western Kenya. Malar. J.7,196 (2008).Crossref, Medline, Google Scholar
46 Clarke SE, Jukes MC, Njagi JK et al. Effect of intermittent preventive treatment of malaria on health and education in schoolchildren: a cluster-randomised, double-blind, placebo-controlled trial. Lancet372(9633),127–138 (2008).Crossref, Medline, Google Scholar
47 Dicko A, Mantel C, Thera MA et al. Risk factors for malaria infection and anemia for pregnant women in the Sahel area of Bandiagara, Mali. Acta Trop.89(1),17–23 (2003).Crossref, Medline, Google Scholar
48 Cisse B, Sokhna C, Boulanger D et al. Seasonal intermittent preventive treatment with artesunate and sulfadoxine-pyrimethamine for prevention of malaria in Senegalese children: a randomised, placebo-controlled, double-blind trial. Lancet367(9511),659–667 (2006).Crossref, Medline, CAS, Google Scholar
49 Massad E, Behrens RH, Burattini MN, Coutinho FA. Modelling the risk of malaria for travelers to areas with stable malaria transmission. Malar. J.8,296 (2009).Crossref, Medline, Google Scholar
50 Behrens RH, Carroll B, Beran J et al. The low and declining risk of malaria in travellers to Latin America: is there still an indication for chemoprophylaxis? Malar. J.6,114 (2007).Crossref, Medline, Google Scholar
51 Behrens RH, Bisoffi Z, Björkman A et al. Malaria prophylaxis policy for travellers from Europe to the Indidan sub continent. Malar. J.5,7 (2006).Crossref, Medline, CAS, Google Scholar
52 Pistone T, Schwarzinger M, Chauvin P et al. Reimbursement of malaria chemoprophylaxis for travellers from Europe to sub-Saharan Africa: cost–effectiveness analysis from the perspective of the French national health insurance system. Health Policy88(2–3),186–199 (2008).Crossref, Medline, Google Scholar
53 Widmer LL, Blank PR, Van Herck K, Hatz C, Schlagenhauf P. Cost–effectiveness analysis of malaria chemoprophylaxis for travellers to west-Africa. BMC Infect. Dis.10,279 (2010).Crossref, Medline, Google Scholar
54 Behrens RH, Carroll B, Hellgren U et al. The incidence of malaria in travellers to South-East Asia: is local malaria transmission a useful risk indicator? Malar. J.9,266 (2010).Crossref, Medline, Google Scholar
55 Massad E, Behrens BC, Coutinho FA, Behrens RH. Cost risk benefit analysis to support chemoprophylaxis policy for travellers to malaria endemic countries. Malar. J.10,130 (2011).Crossref, Medline, Google Scholar
56 Rolland E, Checchi F, Pinoges L, Balkan S, Guthmann JP, Guerin PJ. Operational response to malaria epidemics: are rapid diagnostic tests cost-effective? Trop. Med. Int. Health11(4),398–408 (2006).Crossref, Medline, Google Scholar
57 Reyburn H, Mbatia R, Drakeley C et al. Overdiagnosis of malaria in patients with severe febrile illness in Tanzania: a prospective study. BMJ329(7476),1212 (2004).Crossref, Medline, Google Scholar
58 Noedl H, Se Y, Schaecher K, Smith BL, Socheat D, Fukuda MM. Evidence of artemisinin-resistant malaria in western Cambodia. N. Engl. J. Med.359(24),2619–2620 (2008).▪ Resistance to artesunates will have grave consequences for malaria therapy in the absence of equally effective alternatives.Crossref, Medline, CAS, Google Scholar
59 Dondorp AM, Nosten F, Yi P et al. Artemisinin resistance in Plasmodium falciparum malaria. N. Engl. J. Med.361(5),455–467 (2009).▪ Resistance to artesunates will have grave consequences for malaria therapy in the absence of equally effective alternatives.Crossref, Medline, CAS, Google Scholar
101 WHO. World Malaria Report (2010). http://www.who.int/malaria/world_malaria_report_2010/en/index.htmlGoogle Scholar
102 WHO. Guidelines for the treatment of malaria. Second edition 2010. http://www.who.int/malaria/publications/atoz/9789241547925/en/index.htmlGoogle Scholar
103 WHO. Malaria publications. www.who.int/malaria/publicationsGoogle Scholar

Vol. 6, No. 12

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Published online 28 November 2011

Published in print December 2011

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The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

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