title: Cost-effectiveness analysis of artesunate and quinine + tetracycline for the treatment of uncomplicated falciparum malaria in Chanthaburi, Thailand.
abstract: A randomized, controlled, malaria-clinic-based field trial was carried out to compare the cost-effectiveness of a 5-day 700-mg oral artesunate and a 7-day quinine + tetracycline regimen for the treatment of uncomplicated falciparum malaria in Thailand. Cost-effectiveness was determined from the providers' perspective and based on curative effectiveness. A total of 137 patients, aged 15-60 years, attending a malaria clinic were followed for 28 days, 60 of them received quinine + tetracycline and 77 received artesunate. Cure rates were assessed on day 5 (artesunate) and day 7 (quinine + tetracycline), using the intention-to-treat approach. Cost-effectiveness and sensitivity analyses were performed by varying the day 5/day 7 curative effectiveness and cost of artesunate. The cure rate with artesunate (100%) was significantly higher than with quinine + tetracycline (77.4%) (relative risk adjusted for sex (aRR) = 1.32, 95% confidence interval (CI) = 1.12-1.55; referent quinine + tetracycline). Artesunate was more cost-effective than quinine + tetracycline at the following costs: artesunate, < or = US$0.36 per 50-mg tablet; quinine, US$0.06 per 300-mg tablet; tetracycline, US$0.02 per 250-mg capsule; and services per case found, < or = US$11.49. Because of the higher cure rate and higher cost-effectiveness of the artesunate regimen compared with quinine + tetracycline, we recommend its use for the treatment of uncomplicated falciparum malaria in malaria clinics in Thailand.
authors.affiliation: Research Institute for Tropical Medicine, Department of Health, Muntinlupa City, Metro Manila, Philippines.
authors.forename: E R
authors.initials: ER
authors.lastname: Honrado
authors.forename: W
authors.initials: W
authors.lastname: Fungladda
authors.forename: P
authors.initials: P
authors.lastname: Kamoiratanaku
authors.forename: D
authors.initials: D
authors.lastname: Kitayaporn
authors.forename: J
authors.initials: J
authors.lastname: Karbwang
authors.forename: K
authors.initials: K
authors.lastname: Thimasarn
authors.forename: R
authors.initials: R
authors.lastname: Masngammueng
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000191:economics* / Q000627:therapeutic use; D000962:Antimalarials / Q000191:economics* / Q000627:therapeutic use; D037621:Artemisinins; D000077332:Artesunate; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011803:Quinine / Q000191:economics* / Q000627:therapeutic use; D012717:Sesquiterpenes / Q000191:economics* / Q000627:therapeutic use; D018709:Statistics, Nonparametric; D013752:Tetracycline / Q000191:economics* / Q000627:therapeutic use; D013785:Thailand
chemical_list: D000900:Anti-Bacterial Agents; D000962:Antimalarials; D037621:Artemisinins; D012717:Sesquiterpenes; D000077332:Artesunate; D011803:Quinine; D013752:Tetracycline