title: Cost-effectiveness of pre-referral antimalarial, antibacterial, and combined rectal formulations for severe febrile illness.
abstract: BACKGROUND
  Malaria and bacterial infections account for most infectious disease deaths in developing countries. Prompt treatment saves lives, but rapid deterioration often prevents the use of oral therapies; delays in reaching health facilities providing parenteral interventions are common. Rapidly and reliably absorbed antimalarial/antibacterial rectal formulations used in the community could prevent deaths and disabilities. Rectal antimalarial treatments are currently available; rectal antibacterial treatments are yet to be developed. Assessment of the likely cost-effectiveness of these interventions will inform research priorities and implementation.
  
  
  RESULTS
  The burden of malaria and bacterial infections worldwide and in Sub-Saharan and Southern Africa (SSA) and South and South-East Asia (SEA) was summarised using published data. The additional healthcare costs (US$) per death and per Disability Adjusted Life Year (DALY) avoided following pre-referral treatment of severe febrile illness with rectal antimalarials, antibacterials or combined antimalarial/antibacterials in populations at malaria risk in SSA/SEA were assessed. 46 million severe malaria and bacterial infections and 5 million deaths occur worldwide each year, mostly in SSA/SEA. At annual delivery costs of $0.02/capita and 100% coverage, rectal antimalarials ($2 per dose) would avert 240,000 deaths in SSA and 7,000 deaths in SEA at $5 and $177 per DALY avoided, respectively; rectal antibacterials ($2 per dose) would avert 130,000 deaths in SSA and 27,000 deaths in SEA at $19 and $97 per DALY avoided, respectively. Combined rectal formulations ($2.50 per dose) would avert 370,000 deaths in SSA and 33,000 deaths in SEA at $8 and $79 per DALY avoided, respectively, and are a cost-effective alternative to rectal antimalarials or antibacterials alone.
  
  
  CONCLUSIONS
  Antimalarial, antibacterial and combined rectal formulations are likely to be cost-effective interventions for severe febrile illness in the community. Attention should focus on developing effective rectal antibacterials and ensuring that these lifesaving treatments are used in a cost-effective manner.
authors.affiliation: Department of Public Health, Health Economics Research Centre, University of Oxford, Oxford, United Kingdom.
authors.forename: James
authors.initials: J
authors.lastname: Buchanan
authors.forename: Borislava
authors.initials: B
authors.lastname: Mihaylova
authors.forename: Alastair
authors.initials: A
authors.lastname: Gray
authors.forename: Nicholas
authors.initials: N
authors.lastname: White
mesh_terms: D000285:Administration, Rectal; D000349:Africa; D000890:Anti-Infective Agents / Q000494:pharmacology*; D000962:Antimalarials / Q000494:pharmacology*; D001424:Bacterial Infections / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005334:Fever / Q000188:drug therapy*; D017048:Health Care Costs; D006297:Health Services Accessibility; D006801:Humans; D008288:Malaria / Q000188:drug therapy* / Q000382:microbiology*
chemical_list: D000890:Anti-Infective Agents; D000962:Antimalarials