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DC Field | Value | Language |
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dc.contributor.author | Fernandes, Silke | - |
dc.contributor.author | Sicuri, Elisa | - |
dc.contributor.author | Halimatou, Diawara | - |
dc.contributor.author | Akazili, James | - |
dc.contributor.author | Bojang, Kalifa | - |
dc.contributor.author | Chandramohan, Daniel | - |
dc.contributor.author | Coulibaly, Sheikh | - |
dc.contributor.author | Diawara, Sory Ibrahim | - |
dc.contributor.author | Kayentao, Kassoum | - |
dc.contributor.author | Kuile, Feiko ter | - |
dc.contributor.author | Magnussen, Pascal | - |
dc.contributor.author | Tagbor, Harry | - |
dc.contributor.author | Williams, John | - |
dc.contributor.author | Woukeu, Arouna | - |
dc.contributor.author | Cairns, Matthew | - |
dc.contributor.author | Greenwood, Brian | - |
dc.contributor.author | Hanson, Kara | - |
dc.date.accessioned | 2016-10-07T13:42:04Z | - |
dc.date.available | 2016-10-07T13:42:04Z | - |
dc.date.issued | 2016-09-23 | - |
dc.identifier.issn | 1475-2875 | - |
dc.identifier.uri | http://hdl.handle.net/2445/102456 | - |
dc.description.abstract | Background: Emergence of high-grade sulfadoxine-pyrimethamine (SP) resistance in parts of Africa has led to growing concerns about the efficacy of intermittent preventive treatment of malaria during pregnancy (IPTp) with SP. The incremental cost-effectiveness of intermittent screening and treatment (ISTp) with artemether-lumefantrine (AL) as an alternative strategy to IPTp-SP was estimated followed by a simulation of the effects on cost-effectiveness of decreasing efficacy of IPTp-SP due to SP resistance. The analysis was based on results from a multi-centre, non-inferiority trial conducted in West Africa. Methods: A decision tree model was analysed from a health provider perspective. Model parameters for all trial countries with appropriate ranges and distributions were used in a probabilistic sensitivity analysis. Simulations were performed in hypothetical cohorts of 1000 pregnant women who received either ISTp-AL or IPTp-SP. In addition a cost-consequences analysis was conducted. Trial estimates were used to calculate disability-adjusted-life-years (DALYs) for low birth weight and severe/moderate anaemia (both shown to be non-inferior for ISTp-AL) and clinical malaria (inferior for ISTp-AL). Cost estimates were obtained from observational studies, health facility costings and public procurement databases. Results were calculated as incremental cost per DALY averted. Finally, the cost-effectiveness changes with decreasing SP efficacy were explored by simulation. Results: Relative to IPTp-SP, delivering ISTp-AL to 1000 pregnant women cost US$ 4966.25 more (95 % CI US$ 3703.53; 6376.83) and led to a small excess of 28.36 DALYs (95 % CI −75.78; 134.18), with LBW contributing 81.3 % of this difference. The incremental cost-effectiveness ratio was −175.12 (95 % CI −1166.29; 1267.71) US$/DALY averted. Simulations show that cost-effectiveness of ISTp-AL increases as the efficacy of IPTp-SP decreases, though the specific threshold at which ISTp-AL becomes cost-effective depends on assumptions about the contribution of bed nets to malaria control, bed net coverage and the willingness-to-pay threshold used. Conclusions: At SP efficacy levels currently observed in the trial settings it would not be cost-effective to switch from IPTp-SP to ISTp-AL, mainly due to the substantially higher costs of ISTp-AL and limited difference in outcomes. The modelling results indicate thresholds below which IPT-SP efficacy must fall for ISTp-AL to become a cost-effective option for the prevention of malaria in pregnancy. | - |
dc.format.extent | 13 p. | - |
dc.format.mimetype | application/pdf | - |
dc.language.iso | eng | - |
dc.publisher | BioMed Central | - |
dc.relation.isformatof | Reproducció del document publicat a: http://dx.doi.org/10.1186/s12936-016-1539-4 | - |
dc.relation.ispartof | Malaria Journal, 2016, vol. 15, num. 493 | - |
dc.relation.uri | http://dx.doi.org/10.1186/s12936-016-1539-4 | - |
dc.rights | cc by (c) Fernandes et al., 2016 | - |
dc.rights.uri | http://creativecommons.org/licenses/by/3.0/es/ | - |
dc.source | Articles publicats en revistes (ISGlobal) | - |
dc.subject.classification | Malària | - |
dc.subject.classification | Embaràs | - |
dc.subject.other | Malaria | - |
dc.subject.other | Pregnancy | - |
dc.title | Cost effectiveness of intermittent screening followed by treatment versus intermittent preventive treatment during pregnancy in West Africa: analysis and modelling of results from a non-inferiority trial | - |
dc.type | info:eu-repo/semantics/article | - |
dc.type | info:eu-repo/semantics/publishedVersion | - |
dc.date.updated | 2016-10-05T18:01:07Z | - |
dc.rights.accessRights | info:eu-repo/semantics/openAccess | - |
Appears in Collections: | Articles publicats en revistes (ISGlobal) |
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File | Description | Size | Format | |
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fernandess2016_2254.pdf | 2.9 MB | Adobe PDF | View/Open |
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