title: Cost-effectiveness of dihydroartemisinin-piperaquine compared with artemether-lumefantrine for treating uncomplicated malaria in children at a district hospital in Tanzania.
abstract: BACKGROUND
  Dihydroartemisinin-piperaquine (DhP) is highly recommended for the treatment of uncomplicated malaria. This study aims to compare the costs, health benefits and cost-effectiveness of DhP and artemether-lumefantrine (AL) alongside "do-nothing" as a baseline comparator in order to consider the appropriateness of DhP as a first-line anti-malarial drug for children in Tanzania.
  
  
  METHODS
  A cost-effectiveness analysis was performed using a Markov decision model, from a provider's perspective. The study used cost data from Tanzania and secondary effectiveness data from a review of articles from sub-Saharan Africa. Probabilistic sensitivity analysis was used to incorporate uncertainties in the model parameters. In addition, sensitivity analyses were used to test plausible variations of key parameters and the key assumptions were tested in scenario analyses.
  
  
  RESULTS
  The model predicts that DhP is more cost-effective than AL, with an incremental cost-effectiveness ratio (ICER) of US$ 12.40 per DALY averted. This result relies on the assumption that compliance to treatment with DhP is higher than that with AL due to its relatively simple once-a-day dosage regimen. When compliance was assumed to be identical for the two drugs, AL was more cost-effective than DhP with an ICER of US$ 12.54 per DALY averted. DhP is, however, slightly more likely to be cost-effective compared to a willingness-to-pay threshold of US$ 150 per DALY averted.
  
  
  CONCLUSIONS
  Dihydroartemisinin-piperaquine is a very cost-effective anti-malarial drug. The findings support its use as an alternative first-line drug for treatment of uncomplicated malaria in children in Tanzania and other sub-Saharan African countries with similar healthcare infrastructures and epidemiology of malaria.
authors.affiliation: Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, P,O, Box 7804, 5020 Bergen, Norway. pax_amani@yahoo.com.
authors.forename: Amani T
authors.initials: AT
authors.lastname: Mori
authors.forename: Frida
authors.initials: F
authors.lastname: Ngalesoni
authors.forename: Ole F
authors.initials: OF
authors.lastname: Norheim
authors.forename: Bjarne
authors.initials: B
authors.lastname: Robberstad
mesh_terms: D000962:Antimalarials / Q000191:economics / Q000627:therapeutic use*; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000191:economics / Q000627:therapeutic use*; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D004338:Drug Combinations; D004983:Ethanolamines / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D005449:Fluorenes / Q000191:economics / Q000627:therapeutic use*; D017048:Health Care Costs; D006767:Hospitals, District; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008288:Malaria / Q000188:drug therapy*; D008297:Male; D015233:Models, Statistical; D011804:Quinolines / Q000191:economics / Q000627:therapeutic use*; D013636:Tanzania; D016896:Treatment Outcome; 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