title: Bioeconomic analysis of child-targeted subsidies for artemisinin combination therapies: a cost-effectiveness analysis.
abstract: The Affordable Medicines Facility for malaria (AMFm) was conceived as a global market-based mechanism to increase access to effective malaria treatment and prolong effectiveness of artemisinin. Although results from a pilot implementation suggested that the subsidy was effective in increasing access to high-quality artemisinin combination therapies (ACTs), the Global Fund has converted AMFm into a country-driven mechanism whereby individual countries could choose to fund the subsidy from within their country envelopes. Because the initial costs of the subsidy in the pilot countries was higher than expected, countries are also exploring alternatives to a universal subsidy, such as subsidizing only child doses. We examined the incremental cost-effectiveness of a child-targeted policy using an age-structured bioeconomic model of malaria from the provider perspective. Because the vast majority of malaria deaths occur in children, targeting children could potentially improve the cost-effectiveness of the subsidy, though it would avert significantly fewer deaths. However, the benefits of a child-targeted subsidy (i.e. deaths averted) are eroded as leakage (i.e. older individuals taking young child-targeted doses) increases, with few of the benefits of a universal subsidy gained (i.e. reductions in overall prevalence). Although potentially more cost-effective, a child-targeted subsidy must contain measures to reduce the possibility of leakage.
authors.affiliation: Center for Disease Dynamics, Economics and Policy, Washington, DC, USA Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Eili Y
authors.initials: EY
authors.lastname: Klein
authors.affiliation: Department of Zoology, University of Oxford, Oxford, UK Sanaria Institute for Global Health & Tropical Medicine, Rockville, MD, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Smith
authors.affiliation: Clinton Health Access Initiative, Boston, MA, USA.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Cohen
authors.affiliation: Center for Disease Dynamics, Economics and Policy, Washington, DC, USA Princeton Environmental Institute, Princeton University, Princeton, NJ, USA Public Health Foundation of India, New Delhi, India ramanan@cddep.org.
authors.forename: Ramanan
authors.initials: R
authors.lastname: Laxminarayan
mesh_terms: D037621:Artemisinins / Q000008:administration & dosage / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D004359:Drug Therapy, Combination / Q000191:economics / Q000379:methods; D006801:Humans; D007783:Lactones / Q000008:administration & dosage / Q000191:economics*; D008288:Malaria / Q000188:drug therapy / Q000191:economics*; D008297:Male; D018803:Models, Economic
chemical_list: D037621:Artemisinins; D007783:Lactones; C075875:artemisin
keywords: Affordable Medicines Facility for malaria; Plasmodium falciparum; The Global Fund; anti-malarial drug resistance; child-targeted subsidy