# name
Economic Evaluation of an Alternative Drug to Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment of Malaria in Pregnancy

# metadata.dc.description.abstract[].value
Intermittent preventive treatment in pregnancy
                (IPTp) with sulfadoxine-pyrimethamine (SP) is recommended in
                HIV-negative women to avert malaria, while this relies on
                cotrimoxazole prophylaxis (CTXp) in HIV-positive women.
                Alternative antimalarials are required in areas where parasite
                resistance to antifolate drugs is high. The cost-effectiveness
                of IPTp with alternative drugs is needed to inform policy.
                METHODS: The cost-effectiveness of 2-dose IPTp-mefloquine (MQ)
                was compared with IPTp-SP in HIV-negative women (Benin, Gabon,
                Mozambique and Tanzania). In HIV-positive women the
                cost-effectiveness of 3-dose IPTp-MQ added to CTXp was compared
                with CTXp alone (Kenya, Mozambique and Tanzania). The outcomes
                used were maternal clinical malaria, anaemia at delivery and
                non-obstetric hospital admissions. The poor tolerability to MQ
                was included as the value of women's loss of working days.
                Incremental cost-effectiveness ratios (ICERs) were calculated
                and threshold analysis undertaken. RESULTS: For HIV-negative
                women, the ICER for IPTp-MQ versus IPTp-SP was 136.30 US$ (2012
                US$) (95%CI 131.41; 141.18) per disability-adjusted life-year
                (DALY) averted, or 237.78 US$ (95%CI 230.99; 244.57), depending
                on whether estimates from Gabon were included or not. For
                HIV-positive women, the ICER per DALY averted for IPTp-MQ added
                to CTXp, versus CTXp alone was 6.96 US$ (95%CI 4.22; 9.70). In
                HIV-negative women, moderate shifts of variables such as malaria
                incidence, drug cost, and IPTp efficacy increased the ICERs
                above the cost-effectiveness threshold. In HIV-positive women
                the intervention remained cost-effective for a substantial (up
                to 21 times) increase in cost per tablet. CONCLUSIONS: Addition
                of IPTp with an effective antimalarial to CTXp was very
                cost-effective in HIV-positive women. IPTp with an efficacious
                antimalarial was more cost-effective than IPTp-SP in
                HIV-negative women. However, the poor tolerability of MQ does
                not favour its use as IPTp. Regardless of HIV status, prevention
                of malaria in pregnancy with a highly efficacious, well
                tolerated antimalarial would be cost-effective despite its high
                price. TRIALS REGISTRATION: ClinicalTrials.gov NCT 00811421; Pan
                African Trials Registry PACTR2010020001429343 and
                PACTR2010020001813440.

# metadata.dc.relation.isformatof[].value
Reproducció del document publicat a:
                http://dx.doi.org/10.1371/journal.pone.0125072

# metadata.dc.source[].value
Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Economic Evaluation of an Alternative Drug to Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment of Malaria in Pregnancy