Determinants of the cost-effectiveness of intermittent preventive treatment for malaria in infants and children.

<h4>Background</h4>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...

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Autores principales:	Amanda Ross, Nicolas Maire, Elisa Sicuri, Thomas Smith, Lesong Conteh
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f746ae67e1b44c78b94091775303b629
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spelling	oai:doaj.org-article:f746ae67e1b44c78b94091775303b6292021-12-02T20:11:47ZDeterminants of the cost-effectiveness of intermittent preventive treatment for malaria in infants and children.1932-620310.1371/journal.pone.0018391https://doaj.org/article/f746ae67e1b44c78b94091775303b6292011-04-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21490967/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.Amanda RossNicolas MaireElisa SicuriThomas SmithLesong ContehPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 6, Iss 4, p e18391 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Amanda Ross Nicolas Maire Elisa Sicuri Thomas Smith Lesong Conteh Determinants of the cost-effectiveness of intermittent preventive treatment for malaria in infants and children.
description	<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.
format	article
author	Amanda Ross Nicolas Maire Elisa Sicuri Thomas Smith Lesong Conteh
author_facet	Amanda Ross Nicolas Maire Elisa Sicuri Thomas Smith Lesong Conteh
author_sort	Amanda Ross
title	Determinants of the cost-effectiveness of intermittent preventive treatment for malaria in infants and children.
title_short	Determinants of the cost-effectiveness of intermittent preventive treatment for malaria in infants and children.
title_full	Determinants of the cost-effectiveness of intermittent preventive treatment for malaria in infants and children.
title_fullStr	Determinants of the cost-effectiveness of intermittent preventive treatment for malaria in infants and children.
title_full_unstemmed	Determinants of the cost-effectiveness of intermittent preventive treatment for malaria in infants and children.
title_sort	determinants of the cost-effectiveness of intermittent preventive treatment for malaria in infants and children.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/f746ae67e1b44c78b94091775303b629
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Determinants of the cost-effectiveness of intermittent preventive treatment for malaria in infants and children.

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