title: Contrasting benefits of different artemisinin combination therapies as first-line malaria treatments using model-based cost-effectiveness analysis.
abstract: There are currently several recommended drug regimens for uncomplicated falciparum malaria in Africa. Each has different properties that determine its impact on disease burden. Two major antimalarial policy options are artemether-lumefantrine (AL) and dihydroartemisinin-piperaquine (DHA-PQP). Clinical trial data show that DHA-PQP provides longer protection against reinfection, while AL is better at reducing patient infectiousness. Here we incorporate pharmacokinetic-pharmacodynamic factors, transmission-reducing effects and cost into a mathematical model and simulate malaria transmission and treatment in Africa, using geographically explicit data on transmission intensity and seasonality, population density, treatment access and outpatient costs. DHA-PQP has a modestly higher estimated impact than AL in 64% of the population at risk. Given current higher cost estimates for DHA-PQP, there is a slightly greater cost per case averted, except in areas with high, seasonally varying transmission where the impact is particularly large. We find that a locally optimized treatment policy can be highly cost effective for reducing clinical malaria burden.
authors.affiliation: MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College, London W2 1PG, UK.
authors.forename: Lucy C
authors.initials: LC
authors.lastname: Okell
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Cairns
authors.affiliation: MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College, London W2 1PG, UK.
authors.forename: Jamie T
authors.initials: JT
authors.lastname: Griffin
authors.affiliation: MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College, London W2 1PG, UK.
authors.forename: Neil M
authors.initials: NM
authors.lastname: Ferguson
authors.affiliation: 1] Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LJ, UK [2] Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Nakhon Pathom 73170, Bangkok, Thailand.
authors.forename: Joel
authors.initials: J
authors.lastname: Tarning
authors.affiliation: Medicines for Malaria Venture, 1215 Geneva 15, Switzerland.
authors.forename: George
authors.initials: G
authors.lastname: Jagoe
authors.affiliation: Medicines for Malaria Venture, 1215 Geneva 15, Switzerland.
authors.forename: Pierre
authors.initials: P
authors.lastname: Hugo
authors.affiliation: Medicines for Malaria Venture, 1215 Geneva 15, Switzerland.
authors.forename: Mark
authors.initials: M
authors.lastname: Baker
authors.affiliation: 1] Prince Leopold Institute of Tropical Medicine, Department of Public Health, 2000 Antwerp, Belgium [2] Medical Research Council Unit, PO Box 273 Banjul Fajara, The Gambia [3] Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
authors.affiliation: Department of Medical Microbiology, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands.
authors.forename: Teun
authors.initials: T
authors.lastname: Bousema
authors.affiliation: Medicines for Malaria Venture, 1215 Geneva 15, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Ubben
authors.affiliation: MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College, London W2 1PG, UK.
authors.forename: Azra C
authors.initials: AC
authors.lastname: Ghani
mesh_terms: D000349:Africa; D000962:Antimalarials / Q000191:economics* / Q000627:therapeutic use; D037621:Artemisinins / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004983:Ethanolamines / Q000191:economics / Q000627:therapeutic use; D005449:Fluorenes / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D000078102:Lumefantrine; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000191:economics*; D008962:Models, Theoretical; D011804:Quinolines / Q000191:economics / Q000627:therapeutic use; D012621:Seasons; D010879:Piperazines
chemical_list: D000962:Antimalarials; D037621:Artemisinins; D004983:Ethanolamines; D005449:Fluorenes; D000078102:Lumefantrine; D011804:Quinolines; C039060:artenimol; C031327:artemisinin; C034759:piperaquine; D010879:Piperazines