Cost-effectiveness of malaria intermittent preventive treatment in infants (IPTi) in Mozambique and the United Republic of Tanzania.
OBJECTIVE
To estimate the cost-effectiveness of malaria intermittent preventive treatment in infants (IPTi) using sulfadoxine-pyrimethamine (SP).


METHODS
In two previous IPTi trials in Ifakara (United Republic of Tanzania) and Manhiça (Mozambique), SP was administered three times to infants before 9 months of age through the Expanded Programme on Immunization. Based on the efficacy results of the intervention and on malaria incidence in the target population, an estimate was made of the number of clinical malaria episodes prevented. This number and an assumed case-fatality rate of 1.57% were used, in turn, to estimate the number of disability-adjusted life years (DALY) averted and the number of deaths averted. The cost of the intervention, including start-up and recurrent costs, was then assessed on the basis of these figures.


RESULTS
The cost per clinical episode of malaria averted was US$ 1.57 (range: US$ 0.8-4.0) in Ifakara and US$ 4.73 (range: US$ 1.7-30.3) in Manhiça; the cost per DALY averted was US$ 3.7 (range: US$ 1.6-12.2) in Ifakara and US$ 11.2 (range: US$ 3.6-92.0) in Manhiça; and the cost per death averted was US$ 100.2 (range: US$ 43.0-330.9) in Ifakara and US$ 301.1 (range: US$ 95.6-2498.4) in Manhiça.


CONCLUSIONS
From the health system and societal perspectives, IPTi with SP is expected to produce health improvements in a cost-effective way. From an economic perspective, it offers good value for money for public health programmes.
Hutton
Guy
G
Swiss Tropical Institute, Basel, Switzerland. guy.hutton@dev-sol-int.com
Schellenberg
David
D
Tediosi
Fabrizio
F
Macete
Eusebio
E
Kahigwa
Elizeus
E
Sigauque
Betuel
B
Mas
Xavier
X
Trapero
Marta
M
Tanner
Marcel
M
Trilla
Antoni
A
Alonso
Pedro
P
Menendez
Clara
C
D000962:Antimalarials / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis / Q000191:economics*; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007223:Infant; D008288:Malaria / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D015999:Multivariate Analysis; D011739:Pyrimethamine / Q000191:economics / Q000627:therapeutic use; D013413:Sulfadoxine / Q000191:economics / Q000627:therapeutic use; D013636:Tanzania / Q000453:epidemiology
D000962:Antimalarials; D004338:Drug Combinations; C001205:fanasil, pyrimethamine drug combination; D013413:Sulfadoxine; D011739:Pyrimethamine