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 3. Comparative costs, treatment successes and cost–effectiveness for conventional therapy and three artemisinin combination therapy (ACT) regimens for paediatric uncomplicated malaria, by pathogen species, including worst-case and best-case scenarios under modified intention-to-treat analysis, Papua New Guinea, 2007–2008
| Cost or effectiveness parameter | Plasmodium falciparum |
Plasmodium vivax |
|||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Conventional |
ACT |
Conventional |
ACT |
||||||||
| CQ+S+P | ARTS+S+P | DHA+PQ | A+L | CQ+S+P | ARTS+S+P | DHA+PQ | A+L | ||||
| Per protocol | |||||||||||
| No. of patients | 81 | 103 | 100 | 104 | 46 | 39 | 36 | 33 | |||
| Successes (%) | 82 | 85 | 88 | 95 | 13 | 33 | 69 | 30 | |||
| Mean cost (US$) per patient | 3.50 | 3.90 | 3.69 | 4.46 | 4.03 | 4.60 | 3.93 | 5.19 | |||
| Incremental successes | – | 0.04 | 0.07 | 0.14 | – | 0.20 | 0.56 | 0.17 | |||
| Incremental costs (US$) | – | 0.40 | 0.19 | 0.96 | – | 0.57 | −0.10 | 1.16 | |||
| Incremental cost–effectiveness ratioa | – | 10.21 | 2.95 | 6.97 | – | 2.83 | −0.18 | 6.70 | |||
| Modified intention-to-treat | |||||||||||
| No. of patients | 110 | 122 | 123 | 127 | 61 | 51 | 44 | 39 | |||
| Worst caseb | |||||||||||
| Successes (%) | 60 | 72 | 72 | 78 | 10 | 26 | 57 | 26 | |||
| Mean cost per patient (US$) | 3.48 | 3.98 | 3.93 | 4.48 | 4.08 | 4.40 | 4.03 | 4.99 | |||
| Incremental successes | – | 0.12 | 0.12 | 0.18 | – | 0.16 | 0.47 | 0.16 | |||
| Incremental costs (US$) | – | 0.50 | 0.46 | 1.01 | – | 0.32 | −0.06 | 0.91 | |||
| Incremental cost–effectiveness ratioa | – | 4.12 | 3.97 | 5.59 | – | 2.05 | −0.12 | 5.78 | |||
| Best casec | |||||||||||
| Successes (%) | 86 | 88 | 90 | 96 | 34 | 49 | 75 | 41 | |||
| Mean cost per patient (US$) | 3.48 | 3.98 | 3.93 | 4.48 | 4.08 | 4.40 | 4.03 | 4.99 | |||
| Incremental successes | – | 0.01 | 0.04 | 0.10 | – | 0.15 | 0.41 | 0.07 | |||
| Incremental costs (US$) | – | 0.50 | 0.46 | 1.01 | – | 0.32 | −0.06 | 0.91 | |||
| Incremental cost–effectiveness ratioa | – | 38.31 | 12.00 | 10.37 | – | 2.21 | −0.14 | 13.83 | |||
A, artemether; ARTS, artesunate; CQ, chloroquine; DHA, dihydroartemisinin; L, lumefantrine; P, pyrimethamine; PQ, piperaquine; S, sulfadoxine; US$, United States dollars.
a Incremental cost per incremental treatment success for each novel ACT regimen versus CQ+S+P.
b Worst-case scenario: Early treatment failure assumed for those excluded on or before day 3 and late parasitological failure or late clinical failure assumed for all others.
c Best-case scenario: All missing follow-up blood films were assumed to be parasite-negative.