Cost effectiveness of intermittent screening followed by treatment versus intermittent preventive treatment during pregnancy in West Africa: analysis and modelling of results from a non-inferiority trial

Background: Emergence of high-grade sulfadoxine-pyrimethamine (SP) resistance in parts of Africa has led to growing concerns about the efficacy of intermittent preventive treatment of malaria during pregnancy (IPTp) with SP. The incremental cost-effectiveness of intermittent screening and treatment...

Descripción completa

Detalles Bibliográficos
Autores: Fernandes, Silke, Sicuri, Elisa, Halimatou, Diawara, Akazili, James, Bojang, Kalifa, Chandramohan, Daniel, Coulibaly, Sheikh, Diawara, Sory Ibrahim, Kayentao, Kassoum, Kuile, Feiko ter, Magnussen, Pascal, Tagbor, Harry, Williams, John, Woukeu, Arouna, Cairns, Matthew, Greenwood, Brian, Hanson, Kara
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2016
País:España
Institución:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
Repositorio:Recercat. Dipósit de la Recerca de Catalunya
OAI Identifier:oai:recercat.cat:2445/102456
Acceso en línea:https://hdl.handle.net/2445/102456
Access Level:acceso abierto
Palabra clave:Malària
Embaràs
Malaria
Pregnancy
id ES_7aeec69d5447e63d6a67c6ddc65922ff
oai_identifier_str oai:recercat.cat:2445/102456
network_acronym_str ES
network_name_str España
repository_id_str
spelling Cost effectiveness of intermittent screening followed by treatment versus intermittent preventive treatment during pregnancy in West Africa: analysis and modelling of results from a non-inferiority trialFernandes, SilkeSicuri, ElisaHalimatou, DiawaraAkazili, JamesBojang, KalifaChandramohan, DanielCoulibaly, SheikhDiawara, Sory IbrahimKayentao, KassoumKuile, Feiko terMagnussen, PascalTagbor, HarryWilliams, JohnWoukeu, ArounaCairns, MatthewGreenwood, BrianHanson, KaraMalàriaEmbaràsMalariaPregnancyBackground: Emergence of high-grade sulfadoxine-pyrimethamine (SP) resistance in parts of Africa has led to growing concerns about the efficacy of intermittent preventive treatment of malaria during pregnancy (IPTp) with SP. The incremental cost-effectiveness of intermittent screening and treatment (ISTp) with artemether-lumefantrine (AL) as an alternative strategy to IPTp-SP was estimated followed by a simulation of the effects on cost-effectiveness of decreasing efficacy of IPTp-SP due to SP resistance. The analysis was based on results from a multi-centre, non-inferiority trial conducted in West Africa. Methods: A decision tree model was analysed from a health provider perspective. Model parameters for all trial countries with appropriate ranges and distributions were used in a probabilistic sensitivity analysis. Simulations were performed in hypothetical cohorts of 1000 pregnant women who received either ISTp-AL or IPTp-SP. In addition a cost-consequences analysis was conducted. Trial estimates were used to calculate disability-adjusted-life-years (DALYs) for low birth weight and severe/moderate anaemia (both shown to be non-inferior for ISTp-AL) and clinical malaria (inferior for ISTp-AL). Cost estimates were obtained from observational studies, health facility costings and public procurement databases. Results were calculated as incremental cost per DALY averted. Finally, the cost-effectiveness changes with decreasing SP efficacy were explored by simulation. Results: Relative to IPTp-SP, delivering ISTp-AL to 1000 pregnant women cost US$ 4966.25 more (95 % CI US$ 3703.53; 6376.83) and led to a small excess of 28.36 DALYs (95 % CI −75.78; 134.18), with LBW contributing 81.3 % of this difference. The incremental cost-effectiveness ratio was −175.12 (95 % CI −1166.29; 1267.71) US$/DALY averted. Simulations show that cost-effectiveness of ISTp-AL increases as the efficacy of IPTp-SP decreases, though the specific threshold at which ISTp-AL becomes cost-effective depends on assumptions about the contribution of bed nets to malaria control, bed net coverage and the willingness-to-pay threshold used. Conclusions: At SP efficacy levels currently observed in the trial settings it would not be cost-effective to switch from IPTp-SP to ISTp-AL, mainly due to the substantially higher costs of ISTp-AL and limited difference in outcomes. The modelling results indicate thresholds below which IPT-SP efficacy must fall for ISTp-AL to become a cost-effective option for the prevention of malaria in pregnancy.BioMed Central2016201620162016info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersion13 p.application/pdfhttps://hdl.handle.net/2445/102456Articles publicats en revistes (ISGlobal)reponame:Recercat. Dipósit de la Recerca de Catalunyainstname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)InglésReproducció del document publicat a: http://dx.doi.org/10.1186/s12936-016-1539-4Malaria Journal, 2016, vol. 15, num. 493http://dx.doi.org/10.1186/s12936-016-1539-4cc by (c) Fernandes et al., 2016http://creativecommons.org/licenses/by/3.0/es/info:eu-repo/semantics/openAccessoai:recercat.cat:2445/1024562026-05-29T05:05:01Z
dc.title.none.fl_str_mv Cost effectiveness of intermittent screening followed by treatment versus intermittent preventive treatment during pregnancy in West Africa: analysis and modelling of results from a non-inferiority trial
title Cost effectiveness of intermittent screening followed by treatment versus intermittent preventive treatment during pregnancy in West Africa: analysis and modelling of results from a non-inferiority trial
spellingShingle Cost effectiveness of intermittent screening followed by treatment versus intermittent preventive treatment during pregnancy in West Africa: analysis and modelling of results from a non-inferiority trial
Fernandes, Silke
Malària
Embaràs
Malaria
Pregnancy
title_short Cost effectiveness of intermittent screening followed by treatment versus intermittent preventive treatment during pregnancy in West Africa: analysis and modelling of results from a non-inferiority trial
title_full Cost effectiveness of intermittent screening followed by treatment versus intermittent preventive treatment during pregnancy in West Africa: analysis and modelling of results from a non-inferiority trial
title_fullStr Cost effectiveness of intermittent screening followed by treatment versus intermittent preventive treatment during pregnancy in West Africa: analysis and modelling of results from a non-inferiority trial
title_full_unstemmed Cost effectiveness of intermittent screening followed by treatment versus intermittent preventive treatment during pregnancy in West Africa: analysis and modelling of results from a non-inferiority trial
title_sort Cost effectiveness of intermittent screening followed by treatment versus intermittent preventive treatment during pregnancy in West Africa: analysis and modelling of results from a non-inferiority trial
dc.creator.none.fl_str_mv Fernandes, Silke
Sicuri, Elisa
Halimatou, Diawara
Akazili, James
Bojang, Kalifa
Chandramohan, Daniel
Coulibaly, Sheikh
Diawara, Sory Ibrahim
Kayentao, Kassoum
Kuile, Feiko ter
Magnussen, Pascal
Tagbor, Harry
Williams, John
Woukeu, Arouna
Cairns, Matthew
Greenwood, Brian
Hanson, Kara
author Fernandes, Silke
author_facet Fernandes, Silke
Sicuri, Elisa
Halimatou, Diawara
Akazili, James
Bojang, Kalifa
Chandramohan, Daniel
Coulibaly, Sheikh
Diawara, Sory Ibrahim
Kayentao, Kassoum
Kuile, Feiko ter
Magnussen, Pascal
Tagbor, Harry
Williams, John
Woukeu, Arouna
Cairns, Matthew
Greenwood, Brian
Hanson, Kara
author_role author
author2 Sicuri, Elisa
Halimatou, Diawara
Akazili, James
Bojang, Kalifa
Chandramohan, Daniel
Coulibaly, Sheikh
Diawara, Sory Ibrahim
Kayentao, Kassoum
Kuile, Feiko ter
Magnussen, Pascal
Tagbor, Harry
Williams, John
Woukeu, Arouna
Cairns, Matthew
Greenwood, Brian
Hanson, Kara
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Malària
Embaràs
Malaria
Pregnancy
topic Malària
Embaràs
Malaria
Pregnancy
description Background: Emergence of high-grade sulfadoxine-pyrimethamine (SP) resistance in parts of Africa has led to growing concerns about the efficacy of intermittent preventive treatment of malaria during pregnancy (IPTp) with SP. The incremental cost-effectiveness of intermittent screening and treatment (ISTp) with artemether-lumefantrine (AL) as an alternative strategy to IPTp-SP was estimated followed by a simulation of the effects on cost-effectiveness of decreasing efficacy of IPTp-SP due to SP resistance. The analysis was based on results from a multi-centre, non-inferiority trial conducted in West Africa. Methods: A decision tree model was analysed from a health provider perspective. Model parameters for all trial countries with appropriate ranges and distributions were used in a probabilistic sensitivity analysis. Simulations were performed in hypothetical cohorts of 1000 pregnant women who received either ISTp-AL or IPTp-SP. In addition a cost-consequences analysis was conducted. Trial estimates were used to calculate disability-adjusted-life-years (DALYs) for low birth weight and severe/moderate anaemia (both shown to be non-inferior for ISTp-AL) and clinical malaria (inferior for ISTp-AL). Cost estimates were obtained from observational studies, health facility costings and public procurement databases. Results were calculated as incremental cost per DALY averted. Finally, the cost-effectiveness changes with decreasing SP efficacy were explored by simulation. Results: Relative to IPTp-SP, delivering ISTp-AL to 1000 pregnant women cost US$ 4966.25 more (95 % CI US$ 3703.53; 6376.83) and led to a small excess of 28.36 DALYs (95 % CI −75.78; 134.18), with LBW contributing 81.3 % of this difference. The incremental cost-effectiveness ratio was −175.12 (95 % CI −1166.29; 1267.71) US$/DALY averted. Simulations show that cost-effectiveness of ISTp-AL increases as the efficacy of IPTp-SP decreases, though the specific threshold at which ISTp-AL becomes cost-effective depends on assumptions about the contribution of bed nets to malaria control, bed net coverage and the willingness-to-pay threshold used. Conclusions: At SP efficacy levels currently observed in the trial settings it would not be cost-effective to switch from IPTp-SP to ISTp-AL, mainly due to the substantially higher costs of ISTp-AL and limited difference in outcomes. The modelling results indicate thresholds below which IPT-SP efficacy must fall for ISTp-AL to become a cost-effective option for the prevention of malaria in pregnancy.
publishDate 2016
dc.date.none.fl_str_mv 2016
2016
2016
2016
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/102456
url https://hdl.handle.net/2445/102456
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: http://dx.doi.org/10.1186/s12936-016-1539-4
Malaria Journal, 2016, vol. 15, num. 493
http://dx.doi.org/10.1186/s12936-016-1539-4
dc.rights.none.fl_str_mv cc by (c) Fernandes et al., 2016
http://creativecommons.org/licenses/by/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by (c) Fernandes et al., 2016
http://creativecommons.org/licenses/by/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 13 p.
application/pdf
dc.publisher.none.fl_str_mv BioMed Central
publisher.none.fl_str_mv BioMed Central
dc.source.none.fl_str_mv Articles publicats en revistes (ISGlobal)
reponame:Recercat. Dipósit de la Recerca de Catalunya
instname:Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
instname_str Varias* (Consorci de Biblioteques Universitáries de Catalunya, Centre de Serveis Científics i Acadèmics de Catalunya)
reponame_str Recercat. Dipósit de la Recerca de Catalunya
collection Recercat. Dipósit de la Recerca de Catalunya
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869411476804993024
score 15,811543

Similares en LA Referencia