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

L.C. Okell, M. Cairns, J.T. Griffin, N.M. Ferguson, J. Tarning, G. Jagoe, P. Hugo, M. Baker, Umberto D'Alessandro, T. Bousema, D. Ubben, A.C. Ghani

    Research output: Contribution to journalA1: Web of Science-article

    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.
    Original languageEnglish
    JournalNature Communications
    Volume5
    Pages (from-to)5606
    Number of pages11
    ISSN2041-1723
    DOIs
    Publication statusPublished - 2014

    Keywords

    • Protozoal diseases
    • Malaria
    • Plasmodium falciparum
    • Vectors
    • Mosquitoes
    • Anopheles
    • Artemisinin combination therapies (ACT)
    • ACT
    • First-line drugs
    • Benefits
    • Artemether-lumefantrine
    • Dihydroartemisinin-piperaquine
    • Pharmacokinetics
    • Mathematical modeling
    • Transmission intensity
    • Seasonality
    • Population density
    • Accessibility
    • Outpatients
    • Cost
    • Health impact
    • Cost-effectiveness
    • Africa-General

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