title: An Economic Evaluation of the Posttreatment Prophylactic Effect of Dihydroartemisinin-Piperaquine Versus Artemether-Lumefantrine for First-Line Treatment of Plasmodium falciparum Malaria Across Different Transmission Settings in Africa.
abstract: Malaria disproportionately affects young children. Clinical trials in African children showed that dihydroartemisinin-piperaquine (DP) is an effective antimalarial and has a longer posttreatment prophylactic (PTP) effect against reinfections than other artemisinin-based combination therapies, including artemether-lumefantrine (AL). Using a previously developed Markov model and individual patient data from a multicenter African drug efficacy trial, we assessed the economic value of the PTP effect of DP versus AL in pediatric malaria patients from health-care provider's perspective in low-to-moderate and moderate-to-high transmission settings under different drug co-payment scenarios. In low-to-moderate transmission settings, first-line treatment with DP was highly cost-effective with an incremental cost-effectiveness ratio of US$5 (95% confidence interval [CI] = -76 to 196) per disability-adjusted life year (DALY) averted. In moderate-to-high transmission settings, DP first-line treatment led to a mean cost saving of US$1.09 (95% CI = -0.88 to 3.85) and averted 0.05 (95% CI = -0.08 to 0.22) DALYs per child per year. Our results suggested that DP might be superior to AL for first-line treatment of uncomplicated childhood malaria across a range of transmission settings in Africa.
authors.affiliation: Parasitology Unit, Department for Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany; General Pediatrics Unit, Center for Childhood and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; German Centre for Infectious Diseases (DZIF), University of Tübingen, Tübingen, Germany; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Tropical Diseases Research Centre, Ndola, Zambia; Department of Public Health Research, University of Oxford-KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Steinhardt School of Culture, Education and Human Development, New York University, New York, New York; College of Global Public Health, New York University, New York, New York; Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Pfeil
authors.affiliation: Parasitology Unit, Department for Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany; General Pediatrics Unit, Center for Childhood and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; German Centre for Infectious Diseases (DZIF), University of Tübingen, Tübingen, Germany; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Tropical Diseases Research Centre, Ndola, Zambia; Department of Public Health Research, University of Oxford-KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Steinhardt School of Culture, Education and Human Development, New York University, New York, New York; College of Global Public Health, New York University, New York, New York; Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Borrmann
authors.affiliation: Parasitology Unit, Department for Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany; General Pediatrics Unit, Center for Childhood and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; German Centre for Infectious Diseases (DZIF), University of Tübingen, Tübingen, Germany; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Tropical Diseases Research Centre, Ndola, Zambia; Department of Public Health Research, University of Oxford-KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Steinhardt School of Culture, Education and Human Development, New York University, New York, New York; College of Global Public Health, New York University, New York, New York; Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany.
authors.forename: Quique
authors.initials: Q
authors.lastname: Bassat
authors.affiliation: Parasitology Unit, Department for Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany; General Pediatrics Unit, Center for Childhood and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; German Centre for Infectious Diseases (DZIF), University of Tübingen, Tübingen, Germany; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Tropical Diseases Research Centre, Ndola, Zambia; Department of Public Health Research, University of Oxford-KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Steinhardt School of Culture, Education and Human Development, New York University, New York, New York; College of Global Public Health, New York University, New York, New York; Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany.
authors.forename: Modest
authors.initials: M
authors.lastname: Mulenga
authors.affiliation: Parasitology Unit, Department for Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany; General Pediatrics Unit, Center for Childhood and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; German Centre for Infectious Diseases (DZIF), University of Tübingen, Tübingen, Germany; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Tropical Diseases Research Centre, Ndola, Zambia; Department of Public Health Research, University of Oxford-KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Steinhardt School of Culture, Education and Human Development, New York University, New York, New York; College of Global Public Health, New York University, New York, New York; Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany.
authors.forename: Ambrose
authors.initials: A
authors.lastname: Talisuna
authors.affiliation: Parasitology Unit, Department for Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany; General Pediatrics Unit, Center for Childhood and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany; German Centre for Infectious Diseases (DZIF), University of Tübingen, Tübingen, Germany; ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Tropical Diseases Research Centre, Ndola, Zambia; Department of Public Health Research, University of Oxford-KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Steinhardt School of Culture, Education and Human Development, New York University, New York, New York; College of Global Public Health, New York University, New York, New York; Institute of Public Health, Ruprecht-Karls-University, Heidelberg, Germany tozan@nyu.edu.
authors.forename: Yesim
authors.initials: Y
authors.lastname: Tozan
mesh_terms: D000962:Antimalarials / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D000077611:Artemether, Lumefantrine Drug Combination; D037621:Artemisinins / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D004338:Drug Combinations; D004983:Ethanolamines / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D005449:Fluorenes / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D016778:Malaria, Falciparum / Q000188:drug therapy* / Q000191:economics*; D008390:Markov Chains; D008954:Models, Biological; D018803:Models, Economic; D010963:Plasmodium falciparum; D011804:Quinolines / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D012008:Recurrence; 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