title: Cost risk benefit analysis to support chemoprophylaxis policy for travellers to malaria endemic countries.
abstract: BACKGROUND
  In a number of malaria endemic regions, tourists and travellers face a declining risk of travel associated malaria, in part due to successful malaria control. Many millions of visitors to these regions are recommended, via national and international policy, to use chemoprophylaxis which has a well recognized morbidity profile. To evaluate whether current malaria chemo-prophylactic policy for travellers is cost effective when adjusted for endemic transmission risk and duration of exposure. a framework, based on partial cost-benefit analysis was used.
  
  
  METHODS
  Using a three component model combining a probability component, a cost component and a malaria risk component, the study estimated health costs avoided through use of chemoprophylaxis and costs of disease prevention (including adverse events and pre-travel advice for visits to five popular high and low malaria endemic regions) and malaria transmission risk using imported malaria cases and numbers of travellers to malarious countries. By calculating the minimal threshold malaria risk below which the economic costs of chemoprophylaxis are greater than the avoided health costs we were able to identify the point at which chemoprophylaxis would be economically rational.
  
  
  RESULTS
  The threshold incidence at which malaria chemoprophylaxis policy becomes cost effective for UK travellers is an accumulated risk of 1.13% assuming a given set of cost parameters. The period a travellers need to remain exposed to achieve this accumulated risk varied from 30 to more than 365 days, depending on the regions intensity of malaria transmission.
  
  
  CONCLUSIONS
  The cost-benefit analysis identified that chemoprophylaxis use was not a cost-effective policy for travellers to Thailand or the Amazon region of Brazil, but was cost-effective for travel to West Africa and for those staying longer than 45 days in India and Indonesia.
authors.affiliation: School of Medicine, University of São Paulo and LIM 01 HCFMUSP, Brazil. edmassad@usp.br
authors.forename: Eduardo
authors.initials: E
authors.lastname: Massad
authors.forename: Ben C
authors.initials: BC
authors.lastname: Behrens
authors.forename: Francisco A B
authors.initials: FA
authors.lastname: Coutinho
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Behrens
mesh_terms: D000354:Africa, Western / Q000453:epidemiology; D001938:Brazil / Q000453:epidemiology; D018890:Chemoprevention / Q000191:economics* / Q000379:methods*; D003365:Costs and Cost Analysis; D019353:Endemic Diseases / Q000517:prevention & control*; D006291:Health Policy; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D008288:Malaria / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D015233:Models, Statistical; D018570:Risk Assessment; D013785:Thailand / Q000453:epidemiology; D014195:Travel