Research Summary: Determinants of the Cost-Effectiveness of Intermittent Preventive Treatment for Malaria in Infants and Children

ABSTRACT

Background

Trials of intermittent preventive treatment in infants (IPTi) and children
(IPTc) have shown promising results in reducing malaria episodes but with
varying efficacy and cost-effectiveness. The effects of different
intervention and setting characteristics are not well known. We simulate the
effects of the different target age groups and delivery channels, seasonal
or year-round delivery, transmission intensity, seasonality, proportions of
malaria fevers treated and drug characteristics.


Methods

We use a dynamic, individual-based simulation model of Plasmodium
falciparum
malaria epidemiology, antimalarial drug action and
case management to simulate DALYs averted and the cost per DALY averted by
IPTi and IPTc. IPT cost components were estimated from economic studies
alongside trials.


Results

IPTi and IPTc were predicted to be cost-effective in most of the scenarios
modelled. The cost-effectiveness is driven by the impact on DALYs,
particularly for IPTc, and the low costs, particularly for IPTi which uses
the existing delivery strategy, EPI. Cost-effectiveness was predicted to
decrease with low transmission, badly timed seasonal delivery in a seasonal
setting, short-acting and more expensive drugs, high frequencies of drug
resistance and high levels of treatment of malaria fevers. Seasonal delivery
was more cost-effective in seasonal settings, and year-round in constant
transmission settings. The difference was more pronounced for IPTc than IPTi
due to the different proportions of fixed costs and also different assumed
drug spacing during the transmission season. The number of DALYs averted was
predicted to decrease as a target five-year age-band for IPTc was shifted
from children under 5 years into older ages, except at low transmission
intensities.


Conclusions

Modelling can extend the information available by predicting impact and
cost-effectiveness for scenarios, for outcomes and for multiple strategies
where, for practical reasons, trials cannot be carried out. Both IPTi and
IPTc are generally cost-effective but could be rendered cost-ineffective by
characteristics of the setting, drug or implementation.

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Publisher: Public Library of Science

Date Published: 7-April-2011

Author(s): Ross A., Maire N., Sicuri E., Smith T., Conteh L.

Link: https://doi.org/10.1371/journal.pone.0018391

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