Cost-effectiveness of parenteral artesunate for treating children with severe malaria in sub-Saharan Africa.

Yoel Lubell, Arthorn Riewpaiboon, Arjen Dondorp, Lorenz Von Seidlein, Olugbenga A Mokuolu, Margaret Nansumba, Samwel Gesase, Alison Kent, George Mtove, Rasaq Olaosebikan, Wirichada Pan Ngum, Caterina Fanello, Ilse Hendriksen, Nicholas Day, Nicholas J White, Shunmay Yeung

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective To explore the cost-effectiveness of parenteral artesunate for the treatment of severe malaria in children and its potential impact on hospital budgets. Methods The costs of inpatient care of children with severe malaria were assessed in four of the 11 sites included in the African Quinine Artesunate Malaria Treatment trial, conducted with over 5400 children. The drugs, laboratory tests and intravenous fluids provided to 2300 patients from admission to discharge were recorded, as was the length of inpatient stay, to calculate the cost of inpatient care. The data were matched with pooled clinical outcomes and entered into a decision model to calculate the cost per disability-adjusted life year (DALY) averted and the cost per death averted. Findings The mean cost of treating severe malaria patients was similar in the two study groups: 63.5 United States dollars (US$) (95% confidence interval, CI: 61.7-65.2) in the quinine arm and US$ 66.5 (95% CI: 63.7-69.2) in the artesunate arm. Children treated with artesunate had 22.5% lower mortality than those treated with quinine and the same rate of neurological sequelae: (artesunate arm: 2.3 DALYs per patient; quinine arm: 3.0 DALYs per patient). Compared with quinine as a baseline, artesunate showed an incremental cost per DALY averted and an incremental cost per death averted of US$ 3.8 and US$ 123, respectively. Conclusion Artesunate is a highly cost-effective and affordable alternative to quinine for treating children with severe malaria. The budgetary implications of adopting artesunate for routine use in hospital-based care are negligible.
Original languageEnglish
Pages (from-to)504-512
Number of pages9
JournalBulletin of the World Health Organization
Volume89
Issue number7
DOIs
Publication statusPublished - 2011

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Africa South of the Sahara
Malaria
Cost-Benefit Analysis
Quinine
Costs and Cost Analysis
Inpatients
Quality-Adjusted Life Years
artesunate
Patient Admission
Budgets
Child Care
Length of Stay
Confidence Intervals
Mortality
Therapeutics
Pharmaceutical Preparations

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Lubell, Y., Riewpaiboon, A., Dondorp, A., Von Seidlein, L., Mokuolu, O. A., Nansumba, M., ... Yeung, S. (2011). Cost-effectiveness of parenteral artesunate for treating children with severe malaria in sub-Saharan Africa. Bulletin of the World Health Organization, 89(7), 504-512. https://doi.org/10.2471/BLT.11.085878
Lubell, Yoel ; Riewpaiboon, Arthorn ; Dondorp, Arjen ; Von Seidlein, Lorenz ; Mokuolu, Olugbenga A ; Nansumba, Margaret ; Gesase, Samwel ; Kent, Alison ; Mtove, George ; Olaosebikan, Rasaq ; Ngum, Wirichada Pan ; Fanello, Caterina ; Hendriksen, Ilse ; Day, Nicholas ; White, Nicholas J ; Yeung, Shunmay. / Cost-effectiveness of parenteral artesunate for treating children with severe malaria in sub-Saharan Africa. In: Bulletin of the World Health Organization. 2011 ; Vol. 89, No. 7. pp. 504-512.
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Lubell, Y, Riewpaiboon, A, Dondorp, A, Von Seidlein, L, Mokuolu, OA, Nansumba, M, Gesase, S, Kent, A, Mtove, G, Olaosebikan, R, Ngum, WP, Fanello, C, Hendriksen, I, Day, N, White, NJ & Yeung, S 2011, 'Cost-effectiveness of parenteral artesunate for treating children with severe malaria in sub-Saharan Africa.', Bulletin of the World Health Organization, vol. 89, no. 7, pp. 504-512. https://doi.org/10.2471/BLT.11.085878

Cost-effectiveness of parenteral artesunate for treating children with severe malaria in sub-Saharan Africa. / Lubell, Yoel; Riewpaiboon, Arthorn; Dondorp, Arjen; Von Seidlein, Lorenz; Mokuolu, Olugbenga A; Nansumba, Margaret; Gesase, Samwel; Kent, Alison; Mtove, George; Olaosebikan, Rasaq; Ngum, Wirichada Pan; Fanello, Caterina; Hendriksen, Ilse; Day, Nicholas; White, Nicholas J; Yeung, Shunmay.

In: Bulletin of the World Health Organization, Vol. 89, No. 7, 2011, p. 504-512.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Cost-effectiveness of parenteral artesunate for treating children with severe malaria in sub-Saharan Africa.

AU - Lubell, Yoel

AU - Riewpaiboon, Arthorn

AU - Dondorp, Arjen

AU - Von Seidlein, Lorenz

AU - Mokuolu, Olugbenga A

AU - Nansumba, Margaret

AU - Gesase, Samwel

AU - Kent, Alison

AU - Mtove, George

AU - Olaosebikan, Rasaq

AU - Ngum, Wirichada Pan

AU - Fanello, Caterina

AU - Hendriksen, Ilse

AU - Day, Nicholas

AU - White, Nicholas J

AU - Yeung, Shunmay

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N2 - Objective To explore the cost-effectiveness of parenteral artesunate for the treatment of severe malaria in children and its potential impact on hospital budgets. Methods The costs of inpatient care of children with severe malaria were assessed in four of the 11 sites included in the African Quinine Artesunate Malaria Treatment trial, conducted with over 5400 children. The drugs, laboratory tests and intravenous fluids provided to 2300 patients from admission to discharge were recorded, as was the length of inpatient stay, to calculate the cost of inpatient care. The data were matched with pooled clinical outcomes and entered into a decision model to calculate the cost per disability-adjusted life year (DALY) averted and the cost per death averted. Findings The mean cost of treating severe malaria patients was similar in the two study groups: 63.5 United States dollars (US$) (95% confidence interval, CI: 61.7-65.2) in the quinine arm and US$ 66.5 (95% CI: 63.7-69.2) in the artesunate arm. Children treated with artesunate had 22.5% lower mortality than those treated with quinine and the same rate of neurological sequelae: (artesunate arm: 2.3 DALYs per patient; quinine arm: 3.0 DALYs per patient). Compared with quinine as a baseline, artesunate showed an incremental cost per DALY averted and an incremental cost per death averted of US$ 3.8 and US$ 123, respectively. Conclusion Artesunate is a highly cost-effective and affordable alternative to quinine for treating children with severe malaria. The budgetary implications of adopting artesunate for routine use in hospital-based care are negligible.

AB - Objective To explore the cost-effectiveness of parenteral artesunate for the treatment of severe malaria in children and its potential impact on hospital budgets. Methods The costs of inpatient care of children with severe malaria were assessed in four of the 11 sites included in the African Quinine Artesunate Malaria Treatment trial, conducted with over 5400 children. The drugs, laboratory tests and intravenous fluids provided to 2300 patients from admission to discharge were recorded, as was the length of inpatient stay, to calculate the cost of inpatient care. The data were matched with pooled clinical outcomes and entered into a decision model to calculate the cost per disability-adjusted life year (DALY) averted and the cost per death averted. Findings The mean cost of treating severe malaria patients was similar in the two study groups: 63.5 United States dollars (US$) (95% confidence interval, CI: 61.7-65.2) in the quinine arm and US$ 66.5 (95% CI: 63.7-69.2) in the artesunate arm. Children treated with artesunate had 22.5% lower mortality than those treated with quinine and the same rate of neurological sequelae: (artesunate arm: 2.3 DALYs per patient; quinine arm: 3.0 DALYs per patient). Compared with quinine as a baseline, artesunate showed an incremental cost per DALY averted and an incremental cost per death averted of US$ 3.8 and US$ 123, respectively. Conclusion Artesunate is a highly cost-effective and affordable alternative to quinine for treating children with severe malaria. The budgetary implications of adopting artesunate for routine use in hospital-based care are negligible.

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KW - Sub-Saharan Africa

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