Cost-effectiveness of artemisinin combination therapy for uncomplicated malaria in children: data from Papua New Guinea
Cost-effectiveness of artemisinin combination therapy for uncomplicated malaria in children: data from Papua New Guinea
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DOI：
10.2471/blt.10.084103
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发表时间：
2011-03-01
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影响因子：
--
通讯作者：
Davis, Timothy ME
中科院分区：
文献类型：
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作者：
Davis, Wendy A;Clarke, Philip M;Davis, Timothy ME
目的比较巴布亚新几内亚6 ~ 60月龄儿童常规抗疟治疗与3种青蒿素联合治疗方案的成本-效果。方法对巴布亚新几内亚北部两家诊所的656名恶性疟原虫和间日疟原虫患儿的数据进行增量成本-效果分析。儿童随机分为以下两组：(i)常规治疗：氯喹+磺胺多辛+乙胺嘧啶（CQ+S+P）；（ii）青蒿素加S加P；（iii）双氢青蒿素加哌喹（DHA+PQ）；（iv）蒿甲醚加甲苯胺（A+L）。治疗结果采用世界卫生组织定义。从家到诊所的交通费用加上直接保健费用是确定每一种治疗方案相对于第42天CQ+S+P的每一次治疗成功的增量成本和每节省一个生命年的成本的基础。结果A+L被证明是治疗恶性疟原虫疟疾最有效的方案，并且具有很高的成本效益，每次治疗成功为6.97美元（每挽救生命年约为58美元）。DHA+PQ是治疗间日疟最有效的方案，比CQ+S+P更具成本效益。结论在巴布亚新几内亚部分地区，A+L和DHA+PQ分别是治疗小儿恶性疟原虫和间日疟原虫的高性价比方案。未来的研究将需要确定这些发现是否适用于具有类似疟疾流行病学的亚洲和大洋洲的其他地区。
Objective To compare the cost-effectiveness of conventional antimalarial therapy with that of three artemisinin combination treatment regimens in children from Papua New Guinea aged 6 to 60 months.Methods An incremental cost-effectiveness analysis was performed using data from 656 children with Plasmodium falciparum and/or P. vivax malaria who participated in a large intervention trial in two clinics in northern Papua New Guinea. The children were randomized to one of the following groups: (i) conventional treatment with chloroquine plus sulfadoxine plus pyrimethamine (CQ+S+P); (ii) artesunate plus S plus P; (iii) dihydroartemisinin plus piperaquine (DHA+PQ); and (iv) artemether plus lumefantrine (A+L). For treatment outcomes, World Health Organization definitions were used. The cost of transport between home and the clinic plus direct health-care costs served as a basis for determining each regimen's incremental cost per incremental treatment success relative to CQ+S+P by day 42 and its cost per life year saved.Findings A+L proved to be the most effective regimen against P falciparum malaria and was highly cost-effective at 6.97 United States dollars (US$) per treatment success (about US$ 58 per life year saved). DHA+PQ was the most effective regimen against P vivax malaria and was more cost-effective than CQ+S+P.Conclusion A+L and DHA+PQ are highly cost-effective regimens for the treatment of paediatric P. falciparum and P vivax malaria, respectively, in parts of Papua New Guinea. Future research will be required to determine if these findings hold true for other territories in Asia and Oceania with similar malaria epidemiology.