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 2. Mean cost of treatment per patient and mean cost difference per patient between conventional antimalarial therapy and artemisinin combination therapy (ACT), by malaria pathogen species and for usual care and trial settings, Papua New Guinea, 2007–2008
| Cost item | Mean cost per patient in US$ (± SD) |
Mean cost difference per patient in US$a (95% CI) |
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|---|---|---|---|---|---|---|---|---|---|
| Conventional |
ACT regimen |
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| CQ+S+P | ARTS+S+P | DHA+PQ | A+L | ARTS+S+P vs CQ+S+P |
DHA+PQ vs CQ+S+P |
A+L vs CQ+S+P |
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| Plasmodium falciparum | |||||||||
| No. allocated | 81 | 103 | 100 | 104 | – | – | – | ||
| Antimalarial treatment | 0.04 (± 0.01) | 0.52 (± 0.20)*** | 0.30 (± 0.06)*** | 0.37 (± 0.12)*** | 0.48 (0.43 to 0.52)*** | 0.26 (0.24 to 0.27)*** | 0.33 (0.31 to 0.35)*** | ||
| Milk | – | – | – | 0.48 (± 0.08)*** | – | – | 0.48 (0.46 to 0.49)*** | ||
| Quinine treatment | 0.01 (± 0.05) | 0.01 (± 0.05) | 0.01 (± 0.03) | 0.01 (± 0.05) | 0.00 (−0.02 to 0.01) | −0.01 (−0.02 to 0.00) | 0.00 (−0.01 to 0.02) | ||
| Paracetamol | 0.07 (± 0.05) | 0.06 (± 0.05) | 0.06 (± 0.05) | 0.07 (± 0.06) | 0.00 (−0.02 to 0.02) | −0.01 (−0.02 to 0.01) | 0.00 (−0.01 to 0.02) | ||
| Clinic visits | 3.39 (± 0.78) | 3.30 (± 0.66) | 3.34 (± 0.71) | 3.53 (± 0.95) | −0.08 (−0.30 to 0.12) | −0.05 (−0.28 to 0.17) | 0.14 (−0.11 to 0.39) | ||
| Total (usual care) | 3.50 (± 0.81) | 3.90 (± 0.70)** | 3.69 (± 0.71) | 4.46 (± 0.98)*** | 0.40 (0.17 to 0.61)** | 0.19 (−0.04 to 0.61) | 0.96 (0.69 to 1.21)*** | ||
| Excess costs for trial | 17.98 (± 1.05) | 17.83 (± 2.75) | 18.08 (± 0.89) | 20.47 (± 0.68)*** | −0.16 (−0.79 to 0.26) | 0.10 (−0.18 to 0.40) | 2.49 (2.23 to 2.77)*** | ||
| Total (trial) |
21.48 (± 0.92) |
21.73 (± 2.50) |
21.78 (± 0.99) |
24.93 (± 1.25)*** |
0.24 (−0.36 to 0.69) |
0.29 (−0.01 to 0.57) |
3.44 (3.13 to 3.76)*** |
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| Plasmodium vivax | |||||||||
| No. allocated | 46 | 39 | 36 | 33 | – | – | – | ||
| Antimalarial treatment | 0.03 (± 0.01) | 0.40 (± 0.16)*** | 0.25 (± 0.06)*** | 0.27 (± 0.10)*** | 0.36 (0.32 to 0.41)*** | 0.22 (0.20 to 0.23)*** | 0.23 (0.20 to 0.27)*** | ||
| Milk | – | – | – | 0.46 (± 0.10)*** | – | – | 0.46 (0.46 to 0.46)*** | ||
| Quinine treatment | 0.04 (± 0.07) | 0.04 (± 0.07) | 0.01 (± 0.05) | 0.04 (± 0.09) | 0.00 (−0.03 to 0.03) | −0.03 (−0.05 to 0.00) | 0.01 (−0.03 to 0.05) | ||
| Paracetamol | 0.04 (± 0.05) | 0.04 (± 0.05) | 0.04 (± 0.05) | 0.02 (± 0.04) | 0.00 (−0.02 to 0.02) | 0.00 (−0.02 to 0.02) | −0.02 (−0.04 to 0.00) | ||
| Clinic visits | 3.92 (± 1.33) | 4.13 (± 1.65) | 3.64 (± 1.05) | 4.39 (± 1.61) | 0.21 (−0.41 to 0.87) | −0.29 (−0.81 to 0.23) | 0.47 (−0.19 to 1.13) | ||
| Total (usual care) | 4.03 (± 1.33) | 4.60 (± 1.65) | 3.93 (± 1.06) | 5.19 (± 1.62)** | 0.57 (−0.05 to 1.24) | −0.10 (−0.61 to 0.42) | 1.16 (0.50 to 1.82)** | ||
| Excess costs for trial | 17.98 (± 1.05) | 17.35 (± 3.14) | 18.15 (± 0.61) | 20.40 (± 0.10)*** | −0.63 (−1.79 to 0.12) | 0.17 (−0.19 to 0.53) | 2.42 (1.95 to 2.85)*** | ||
| Total (trial) | 22.01 (± 1.48) | 21.95 (± 3.17) | 22.07 (± 1.12) | 25.59 (± 1.71)*** | −0.06 (−1.24 to 0.91) | 0.07 (−0.51 to 0.64) | 3.58 (2.86 to 4.31)*** | ||
A, artemether; ARTS, artesunate; CI, confidence interval; CQ, chloroquine; DHA, dihydroartemisinin; L, lumefantrine; P, pyrimethamine; PQ, piperaquine; S, sulfadoxine; SD, standard deviation; US$, United States dollars; *P < 0.05;**P < 0.01; ***P < 0.001 (with adjustment for multiple comparisons following Bonferroni’s method).
a Negative cost differences indicate the cost savings associated with ACT.