dc.contributor.author | Kühl, Melf-Jakob | |
dc.contributor.author | Gondwe, Thandile | |
dc.contributor.author | Dhabangi, Aggrey | |
dc.contributor.author | Kwambai, Titus K. | |
dc.contributor.author | Mori, Amani Thomas | |
dc.contributor.author | Opoka, Robert | |
dc.contributor.author | John, C. Chandy | |
dc.contributor.author | Idro, Richard | |
dc.contributor.author | ter Kuile, Feiko O. | |
dc.contributor.author | Phiri, Kamija S. | |
dc.contributor.author | Robberstad, Bjarne | |
dc.date.accessioned | 2022-12-30T11:03:21Z | |
dc.date.available | 2022-12-30T11:03:21Z | |
dc.date.created | 2022-11-08T10:11:52Z | |
dc.date.issued | 2022 | |
dc.identifier.issn | 2589-5370 | |
dc.identifier.uri | https://hdl.handle.net/11250/3040062 | |
dc.description.abstract | Background
Children hospitalised with severe anaemia in malaria-endemic areas are at a high risk of dying or being readmitted within six months of discharge. A trial in Kenya and Uganda showed that three months of postdischarge malaria chemoprevention (PDMC) with monthly dihydroartemisinin-piperaquine (DP) substantially reduced this risk. The World Health Organization recently included PDMC in its malaria chemoprevention guidelines. We conducted a cost-effectiveness analysis of community-based PDMC delivery (supplying all three PDMC-DP courses to caregivers at discharge to administer at home), facility-based PDMC delivery (monthly dispensing of PDMC-DP at the hospital), and the standard of care (no PDMC).
Methods
We combined data from two recently completed trials; one placebo-controlled trial in Kenya and Uganda collecting efficacy data (May 6, 2016 until November 15, 2018; n=1049), and one delivery mechanism trial from Malawi collecting adherence data (March 24, 2016 until October 3, 2018; n=375). Cost data were collected alongside both trials. Three Markov decision models, one each for Malawi, Kenya, and Uganda, were used to compute incremental cost-effectiveness ratios expressed as costs per quality-adjusted life-year (QALY) gained. Deterministic and probabilistic sensitivity analyses were performed to account for uncertainty.
Findings
Both PDMC strategies were cost-saving in each country, meaning less costly and more effective in increasing health-adjusted life expectancy than the standard of care. The estimated incremental cost savings for community-based PDMC compared to the standard of care were US$ 22·10 (Malawi), 38·52 (Kenya), and 26·23 (Uganda) per child treated. The incremental effectiveness gain using either PDMC strategy varied between 0·3 and 0·4 QALYs. Community-based PDMC was less costly and more effective than facility-based PDMC. These results remained robust in sensitivity analyses.
Interpretation
PDMC under implementation conditions is cost-saving. Caregivers receiving PDMC at discharge is a cost-effective delivery strategy for implementation in malaria-endemic southeastern African settings. | en_US |
dc.language.iso | eng | en_US |
dc.publisher | Elsevier | en_US |
dc.rights | Navngivelse 4.0 Internasjonal | * |
dc.rights.uri | http://creativecommons.org/licenses/by/4.0/deed.no | * |
dc.title | Economic evaluation of postdischarge malaria chemoprevention in preschool children treated for severe anaemia in Malawi, Kenya, and Uganda: A cost-effectiveness analysis | en_US |
dc.type | Journal article | en_US |
dc.type | Peer reviewed | en_US |
dc.description.version | publishedVersion | en_US |
dc.rights.holder | Copyright 2022 The Author(s) | en_US |
dc.source.articlenumber | 101669 | en_US |
cristin.ispublished | true | |
cristin.fulltext | original | |
cristin.qualitycode | 1 | |
dc.identifier.doi | 10.1016/j.eclinm.2022.101669 | |
dc.identifier.cristin | 2070410 | |
dc.source.journal | EClinicalMedicine | en_US |
dc.identifier.citation | EClinicalMedicine. 2022, 52, 101669. | en_US |
dc.source.volume | 52 | en_US |