Cost–effectiveness of artemisinin combination therapy for uncomplicated malaria in children: data from Papua New Guinea
Wendy A Davis, Philip M Clarke, Peter M Siba, Harin A Karunajeewa, Carol Davy, Ivo Mueller & Timothy ME Davis
Volume 89, Number 3, March 2011, 211-220
Table 1. Main unit costs associated with participation in randomized four-arm trial in children aged 6–60 months with uncomplicated malaria, Papua New Guinea, 2007–2008
| Cost item | Unit cost (2007–08 US$) |
Price source | Comment |
|---|---|---|---|
| Health clinic visit | |||
| Outpatient | 0.517 | Alexishafen Health Clinic, Madang | Per treatment course paid for at first visit |
| Inpatient | 3.44 | Alexishafen Health Clinic, Madang | One-off admission fee regardless of no. of nights |
| Transport to health clinica | 1.72 | Alexishafen Health Clinic, Madang | 5 (usual) to 20 (far) PGKb round trip |
| Malaria treatment | – | ||
| CQ, 150 mg | 0.010 | MTEFc 2006–07 prices | – |
| S+P: 500 mg of S, 25 mg of P | 0.013 | MTEF 2006–07 prices | – |
| ARTS, 50 mg | 0.184 | MTEF 2006–07 prices | – |
| DHA+PQ: 40 mg of DHA, 320 mg of PQ | 0.137 | Beijing Holley Cotec, China | US$ 0.125 per tablet |
| A+L: 20 mg of A, 120 mg of L | 0.0617 | Novartis Pharma AG price to WHO, 2008 | – |
| Quinine sulfate tablets, 300 mg | 0.022 | MTEF 2006–07 prices | – |
| Quinine dihydrochloride, 300 mg/ml, 2 ml | 0.241 | MTEF 2006–07 prices | – |
| Tests and other medications | – | ||
| Hb finger prick test | 0.107 | MTEF 2006–07 prices | On days 0–42 and sick days |
| Paracetamol syrup, 120 mg/5 ml | 0.00057/ml | MTEF 2006–07 prices | 15 mg/kg, if axillary temperature ≥ 37.5 °C |
| Albendazole, 200 mg tablet | 0.007` | MTEF 2006–07 prices | For hookworm, on day 42 if Hb < 10 g/dl |
| FeSO4, 200 mg; folic acid, 500 μg | 0.001 | MTEF 2006–07 prices | On day 42 if Hb < 10 g/dl |
| Amodiaquine, 100 mg tablet | 0.005 | MTEF 2006–07 prices | On day 42 if Hb < 10 g/dl and splenomegaly ≥ grade 3d |
| Other costse | – | ||
| Milk, 250 ml tetra packs full cream (32.15 PGK per 24 packs) | 0.462 | Wholesale, 2008 | – |
| Malaria microscopy | 0.710 | MTEF 2006–07 prices | – |
| Syringe, disposable 10 ml, 21-gauge needle | 0.046 | MTEF 2006–07 prices | – |
| Gloves, disposable | 0.004 a pair | MTEF 2006–07 prices | – |
| Blood lancet, disposable | 0.043 | MTEF 2006–07 prices | – |
| Alcohol wipe, 1 per blood sample (9.30 PGK per box of 200 sealed wipes) | 0.016 | Retail pharmacy, 2008 | – |
| Cotton wool swab, 1 per blood sample | 0.007 | MTEF 2006–07 prices | – |
A, artemether; ARTS, artesunate; CQ, chloroquine; DHA, dihydroartemisinin; FeSO4, ferrous sulfate; ; Hb, haemoglobin; L, lumefantrine; MTEF: Medium-Term Expenditure Framework; P, pyrimethamine; PGK, Papua New Guinea kina; PQ, piperaquine; S, sulfadoxine; US$, United States dollars; WHO, World Health Organization.
a Based on cost of travel, by public transport, for the average distance to the clinic in the surrounding area.
b One PGK is equivalent to US$ 0.345 (2007–08).
c Framework of the Papua New Guinea National Department of Health.
d Hackett grade 3: spleen palpable between Grade 2 limit (halfway between left costal margin and level of umbilicus) and level of umbilicus.
e Inpatients and their families need to provide their own food and cooking facilities. Patients who are very sick go to hospital; others visit the local health clinic. In this study no child was referred to hospital.