title: Dihydroartemisinin-piperaquine vs. artemether-lumefantrine for first-line treatment of uncomplicated malaria in African children: a cost-effectiveness analysis.
abstract: BACKGROUND
  Recent multi-centre trials showed that dihydroartemisinin-piperaquine (DP) was as efficacious and safe as artemether-lumefantrine (AL) for treatment of young children with uncomplicated P. falciparum malaria across diverse transmission settings in Africa. Longitudinal follow-up of patients in these trials supported previous findings that DP had a longer post-treatment prophylactic effect than AL, reducing the risk of reinfection and conferring additional health benefits to patients, particularly in areas with moderate to high malaria transmission.
  
  
  METHODS
  We developed a Markov model to assess the cost-effectiveness of DP versus AL for first-line treatment of uncomplicated malaria in young children from the provider perspective, taking into consideration the post-treatment prophylactic effects of the drugs as reported by a recent multi-centre trial in Africa and using the maximum manufacturer drug prices for artemisinin-based combination therapies set by the Global Fund in 2013. We estimated the price per course of treatment threshold above which DP would cease to be a cost-saving alternative to AL as a first-line antimalarial drug.
  
  
  RESULTS
  First-line treatment with DP compared to AL averted 0.03 DALYs (95% CI: 0.006-0.07) and 0.001 deaths (95% CI: 0.00-0.002) and saved $0.96 (95% CI: 0.33-2.46) per child over one year. The results of the threshold analysis showed that DP remained cost-saving over AL for any DP cost below $1.23 per course of treatment.
  
  
  CONCLUSIONS
  DP is superior to AL from both the clinical and economic perspectives for treatment of uncomplicated P. falciparum malaria in young children. A paediatric dispersible formulation of DP is under development and should facilitate a targeted deployment of this antimalarial drug. The use of DP as first-line antimalarial drug in paediatric malaria patients in moderate to high transmission areas of Africa merits serious consideration by health policymakers.
authors.affiliation: Centre for Childhood and Adolescent Medicine and Department of Infectious Diseases, University Hospital, Heidelberg, Germany; German Centre for Infection Research (DZIF), Heidelberg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Pfeil
authors.affiliation: Kenyan Medical Research Institute (KEMRI), Kilifi, Kenya; Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Borrmann
authors.affiliation: Steinhardt School of Culture, Education and Human Development, New York University, New York, New York, United States of America; Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany.
authors.forename: Yeşim
authors.initials: Y
authors.lastname: Tozan
mesh_terms: D000349:Africa; D000962:Antimalarials / Q000191:economics / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000008:administration & dosage; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D004359:Drug Therapy, Combination / Q000191:economics; D004983:Ethanolamines / Q000008:administration & dosage; D005449:Fluorenes / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000188:drug therapy*; D008390:Markov Chains; D017063:Outcome Assessment, Health Care; D011804:Quinolines / Q000008:administration & dosage; D010879:Piperazines
chemical_list: D000962:Antimalarials; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins; D004338:Drug Combinations; D004983:Ethanolamines; D005449:Fluorenes; D011804:Quinolines; C039060:artenimol; C034759:piperaquine; D010879:Piperazines
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