Assessing the cost–effectiveness of prereferral rectal artesunate for treatment of severe childhood malaria

Abstract

Evaluation of: Tozan Y, Klein EY, Darley S, Panicker R, Laxminarayan R, Breman JG. Prereferral rectal artesunate for treatment of severe childhood malaria: a cost–effectiveness analysis. Lancet 376(9756), 1910–1915 (2010).

Tozan and colleagues present the first detailed cost–effectiveness study of community-based prereferral artesunate treatment of children suspected of having severe malaria in areas with poor access to formal healthcare. Modeling a cohort of 1000 newborn babies up to 5 years of age, the cost–effectiveness (in 2008 international dollars [I$]) of the intervention is reported from the provider perspective. Cost–effectiveness results are presented for scenarios with low (25%), moderate (50%), high (75%) and full (100%) intervention uptake and referral compliance. At low intervention uptake and referral compliance, the intervention is estimated to avert 19 disability-adjusted life-years (DALYs; 95% CI: 16–21) and to cost I$1173 (95% CI: 1050–1297) per DALY averted. Under the full uptake and compliance scenario, the intervention averts 967 DALYs (95% CI: 884–1050) at a cost of I$77 (95% CI: 73–81) per DALY averted. Tozan and colleagues’ findings suggest that prereferral artesunate treatment is a cost-effective, life-saving intervention in rural African settings where functioning community health workers exist.

Keywords::

• Africa
• community-based
• cost–effectiveness
• prereferral rectal artesunate
• severe malaria

Acknowledgement

The authors thank Amanda Ross for her helpful comments on this article.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Notes

MDG: Millennium Development Goal.

Data from [5].

Data from [6].