A cost-effectiveness analysis of three antimalarial treatments for acute, uncomplicated Plasmodium falciparum malaria in Mumbai, India.
BACKGROUND
Malaria is a major public health problem representing 2.3% of the overall global disease burden. The cost of treatment of malaria continues to rise as older drugs and insecticides become less effective and are replaced by more effective, but also more expensive products.


METHODS
A post-hoc pharmacoeconomic analysis (direct and indirect costs only) of three antimalarials, chloroquine, mefloquine and co-artemether, was carried out to address the problem of switch to a more expensive first-line antimalarial in the face of growing chloroquine resistance.


RESULTS
From the perspective of a large public hospital, it was seen that in an area of high grade chloroquine resistance, the total expenditure on patients who fail chloroquine would exceed the excess expenditure on mefloquine when the RII + RIII resistance exceeded 9%.


CONCLUSIONS
Switch to a more expensive drug like mefloquine as a first-line option would be cost-effective when the moderate-severe chloroquine resistance exceeded 9%.
Gogtay
N J
NJ
Department of Clinical Pharmacology, 100 Bedded Building, 4th Floor, TN Medical College and BYL Nair Ch. Hospital, Dr AL Nair Road, Mumbai Central, Mumbai-400 008, India.
Kadam
V S
VS
Desai
S
S
Kamtekar
K D
KD
Dalvi
S S
SS
Kshirsagar
N A
NA
D000962:Antimalarials / Q000191:economics* / Q000627:therapeutic use; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000191:economics / Q000627:therapeutic use; D002738:Chloroquine / Q000191:economics / Q000627:therapeutic use; D002986:Clinical Trials as Topic / Q000191:economics; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D017850:Economics, Pharmaceutical; D004983:Ethanolamines; D005260:Female; D005449:Fluorenes / Q000191:economics / Q000627:therapeutic use; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007194:India; D016778:Malaria, Falciparum / Q000188:drug therapy / Q000191:economics*; D008297:Male; D015767:Mefloquine / Q000191:economics / Q000627:therapeutic use; D012717:Sesquiterpenes / Q000191:economics / Q000627:therapeutic use
D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D012717:Sesquiterpenes; D002738:Chloroquine; D015767:Mefloquine