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Contrasting benefits of different artemisinin combination therapies as first-line malaria treatments using model-based cost-effectiveness analysis

Author

Listed:
  • Lucy C. Okell

    (MRC Centre for Outbreak Analysis and Modelling, Imperial College)

  • Matthew Cairns

    (MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine)

  • Jamie T. Griffin

    (MRC Centre for Outbreak Analysis and Modelling, Imperial College)

  • Neil M. Ferguson

    (MRC Centre for Outbreak Analysis and Modelling, Imperial College)

  • Joel Tarning

    (Centre for Tropical Medicine, University of Oxford
    Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University)

  • George Jagoe

    (Medicines for Malaria Venture)

  • Pierre Hugo

    (Medicines for Malaria Venture)

  • Mark Baker

    (Medicines for Malaria Venture)

  • Umberto D’Alessandro

    (Prince Leopold Institute of Tropical Medicine
    Medical Research Council Unit
    Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine)

  • Teun Bousema

    (Radboud University Medical Centre)

  • David Ubben

    (Medicines for Malaria Venture)

  • Azra C. Ghani

    (MRC Centre for Outbreak Analysis and Modelling, Imperial College)

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.

Suggested Citation

  • Lucy C. Okell & Matthew Cairns & Jamie T. Griffin & Neil M. Ferguson & Joel Tarning & George Jagoe & Pierre Hugo & Mark Baker & Umberto D’Alessandro & Teun Bousema & David Ubben & Azra C. Ghani, 2014. "Contrasting benefits of different artemisinin combination therapies as first-line malaria treatments using model-based cost-effectiveness analysis," Nature Communications, Nature, vol. 5(1), pages 1-11, December.
    • Handle: RePEc:nat:natcom:v:5:y:2014:i:1:d:10.1038_ncomms6606
    DOI: 10.1038/ncomms6606
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    Cited by:

    1. Lucy C. Okell & Titus K. Kwambai & Aggrey Dhabangi & Carole Khairallah & Thandile Nkosi-Gondwe & Peter Winskill & Robert Opoka & Andria Mousa & Melf-Jakob Kühl & Tim C. D. Lucas & Joseph D. Challenger, 2023. "Projected health impact of post-discharge malaria chemoprevention among children with severe malarial anaemia in Africa," Nature Communications, Nature, vol. 14(1), pages 1-10, December.
    2. Natasha Howard & Lorna Guinness & Mark Rowland & Naeem Durrani & Kristian S Hansen, 2017. "Cost-effectiveness of adding indoor residual spraying to case management in Afghan refugee settlements in Northwest Pakistan during a prolonged malaria epidemic," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 11(10), pages 1-18, October.

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