Contrasting benefits of different artemisinin combination therapies as first-line malaria treatments using model-based cost-effectiveness analysis

Lucy C. Okell (), Matthew Cairns, Jamie T. Griffin, Neil M. Ferguson, Joel Tarning, George Jagoe, Pierre Hugo, Mark Baker, Umberto D’Alessandro, Teun Bousema, David Ubben and Azra C. Ghani
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Lucy C. Okell: MRC Centre for Outbreak Analysis and Modelling, Imperial College
Matthew Cairns: MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine
Jamie T. Griffin: MRC Centre for Outbreak Analysis and Modelling, Imperial College
Neil M. Ferguson: MRC Centre for Outbreak Analysis and Modelling, Imperial College
Joel Tarning: Centre for Tropical Medicine, University of Oxford
George Jagoe: Medicines for Malaria Venture
Pierre Hugo: Medicines for Malaria Venture
Mark Baker: Medicines for Malaria Venture
Umberto D’Alessandro: Prince Leopold Institute of Tropical Medicine
Teun Bousema: Radboud University Medical Centre
David Ubben: Medicines for Malaria Venture
Azra C. Ghani: MRC Centre for Outbreak Analysis and Modelling, Imperial College

Nature Communications, 2014, vol. 5, issue 1, 1-11

Abstract: Abstract There are currently several recommended drug regimens for uncomplicated falciparum malaria in Africa. Each has different properties that determine its impact on disease burden. Two major antimalarial policy options are artemether–lumefantrine (AL) and dihydroartemisinin–piperaquine (DHA–PQP). Clinical trial data show that DHA–PQP provides longer protection against reinfection, while AL is better at reducing patient infectiousness. Here we incorporate pharmacokinetic-pharmacodynamic factors, transmission-reducing effects and cost into a mathematical model and simulate malaria transmission and treatment in Africa, using geographically explicit data on transmission intensity and seasonality, population density, treatment access and outpatient costs. DHA–PQP has a modestly higher estimated impact than AL in 64% of the population at risk. Given current higher cost estimates for DHA–PQP, there is a slightly greater cost per case averted, except in areas with high, seasonally varying transmission where the impact is particularly large. We find that a locally optimized treatment policy can be highly cost effective for reducing clinical malaria burden.

Date: 2014
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DOI: 10.1038/ncomms6606

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