title: Cost of treating inpatient falciparum malaria on the Thai-Myanmar border.
abstract: BACKGROUND
  Despite demonstrated benefits and World Health Organization (WHO) endorsement, parenteral artesunate is the recommended treatment for patients with severe Plasmodium falciparum malaria in only one fifth of endemic countries. One possible reason for this slow uptake is that a treatment course of parenteral artesunate is costlier than quinine and might, therefore, pose a substantial economic burden to health care systems. This analysis presents a detailed account of the resources used in treating falciparum malaria by either parenteral artesunate or quinine in a hospital on the Thai-Myanmar border.
  
  
  METHODS
  The analysis used data from four studies, with random allocation of inpatients with falciparum malaria to treatment with parenteral artesunate or quinine, conducted in Mae Sot Hospital, Thailand from 1995 to 2001. Detailed resource use data were collected during admission and unit costs from the 2008 hospital price list were applied to these. Total admission costs were broken down into five categories: 1) medication; 2) intravenous fluids; 3) disposables; 4) laboratory tests; and 5) services.
  
  
  RESULTS
  While the medication costs were higher for patients treated with artesunate, total admission costs were similar in those treated with quinine, US$ 243 (95% CI: 167.5-349.7) and in those treated with artesunate US$ 190 (95% CI: 131.0-263.2) (P=0.375). For cases classified as severe malaria (59%), the total cost of admission was US$ 298 (95% CI: 203.6-438.7) in the quinine group as compared with US$ 284 (95% CI: 181.3-407) in the artesunate group (P=0.869).
  
  
  CONCLUSIONS
  This analysis finds no evidence for a difference in total admission costs for malaria inpatients treated with artesunate as compared with quinine. Assuming this is generalizable to other settings, the higher cost of a course of artesunate should not be considered a barrier for its implementation in the treatment of malaria.
authors.affiliation: Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand. shwesin@tropmedres.ac.
authors.forename: Shwe Sin
authors.initials: SS
authors.lastname: Kyaw
authors.forename: Tom
authors.initials: T
authors.lastname: Drake
authors.forename: Ronatrai
authors.initials: R
authors.lastname: Ruangveerayuth
authors.forename: Wirongrong
authors.initials: W
authors.lastname: Chierakul
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: White
authors.forename: Paul N
authors.initials: PN
authors.lastname: Newton
authors.forename: Yoel
authors.initials: Y
authors.lastname: Lubell
mesh_terms: D000328:Adult; D000962:Antimalarials / Q000191:economics* / Q000627:therapeutic use*; D037621:Artemisinins / Q000191:economics / Q000627:therapeutic use; D000077332:Artesunate; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000191:economics*; D008297:Male; D002052:Myanmar; D011803:Quinine / Q000191:economics / Q000627:therapeutic use; D013785:Thailand; D055815:Young Adult
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D000077332:Artesunate; D011803:Quinine