title: Financial implications of refugee malaria: the impact of pre-departure presumptive treatment with anti-malarial drugs.
abstract: This study is a cost-benefits analysis of the recommendations of the Centers for Disease Control and Prevention for presumptive anti-malarial treatment among departing West African refugees. We conducted a retrospective chart review of symptomatic, blood smear-positive cases of malaria seen in Minneapolis, Minnesota, from 1996 through 2005. Billing charges of U.S. care were compared with estimates of implementation costs for overseas treatment. Fifty-eight symptomatic malaria infections occurred among West African refugees. After overseas pre-departure presumptive treatment, symptomatic malaria in arriving refugees decreased from 8.2% to 0%. The pre-departure number needed to treat to prevent one case of symptomatic malaria is 13.9 (95% confidence interval = 9.8-24). The average U.S. billing charge for each malaria case is $1,730. Overseas implementation costs for presumptive treatment are estimated to be between $141 and $346 to prevent one U.S. malaria case. Overseas presumptive pre-departure anti-malarial therapy prevents clinical malaria in refugees and results in cost-benefits when the malaria prevalence is > 1%. Overseas presumptive therapy has greater cost-benefits than U.S. based screening and treatment strategies.
authors.affiliation: Hennepin County Medical Center, Minneapolis, Minnesota; Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Stefan
authors.initials: S
authors.lastname: Collinet-Adler
authors.forename: William M
authors.initials: WM
authors.lastname: Stauffer
authors.forename: David R
authors.initials: DR
authors.lastname: Boulware
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Larsen
authors.forename: Tyson B
authors.initials: TB
authors.lastname: Rogers
authors.forename: David N
authors.initials: DN
authors.lastname: Williams
mesh_terms: D000349:Africa; D000962:Antimalarials / Q000008:administration & dosage* / Q000191:economics* / Q000627:therapeutic use; D001210:Asia, Southeastern; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000191:economics; D008297:Male; D008910:Minnesota; D012036:Refugees; D013997:Time Factors