# name
Cost-effectiveness of two versus three or more doses of intermittent preventive treatment for malaria during pregnancy in sub-Saharan Africa: a modelling study of meta-analysis and cost data

# metadata.dc.description.abstract[].value
BACKGROUND: In 2012, WHO changed its recommendation for
                intermittent preventive treatment of malaria during pregnancy
                (IPTp) from two doses to monthly doses of
                sulfadoxine-pyrimethamine during the second and third
                trimesters, but noted the importance of a cost-effectiveness
                analysis to lend support to the decision of policy makers. We
                therefore estimated the incremental cost-effectiveness of IPTp
                with three or more (IPTp-SP3+) versus two doses of
                sulfadoxine-pyrimethamine (IPTp-SP2). METHODS: For this
                analysis, we used data from a 2013 meta-analysis of seven
                studies in sub-Saharan Africa. We developed a decision tree
                model with a lifetime horizon. We analysed the base case from a
                societal perspective. We did deterministic and probabilistic
                sensitivity analyses with appropriate parameter ranges and
                distributions for settings with low, moderate, and high
                background risk of low birthweight, and did a separate analysis
                for HIV-negative women. Parameters in the model were obtained
                for all countries included in the original meta-analysis. We did
                simulations in hypothetical cohorts of 1000 pregnant women
                receiving either IPTp-SP3+ or IPTp-SP2. We calculated
                disability-adjusted life-years (DALYs) for low birthweight,
                severe to moderate anaemia, and clinical malaria. We calculated
                cost estimates from data obtained in observational studies, exit
                surveys, and from public procurement databases. We give
                financial and economic costs in constant 2012 US$. The main
                outcome measure was the incremental cost per DALY averted.
                FINDINGS: The delivery of IPTp-SP3+ to 1000 pregnant women
                averted 113.4 DALYs at an incremental cost of $825.67 producing
                an incremental cost-effectiveness ratio (ICER) of $7.28 per DALY
                averted. The results remained robust in the deterministic
                sensitivity analysis. In the probabilistic sensitivity analyses,
                the ICER was $7.7 per DALY averted for moderate risk of low
                birthweight, $19.4 per DALY averted for low risk, and $4.0 per
                DALY averted for high risk. The ICER for HIV-negative women was
                $6.2 per DALY averted. INTERPRETATION: Our findings lend strong
                support to the WHO guidelines that recommend a monthly dose of
                IPTp-SP from the second trimester onwards.

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Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Cost-effectiveness of two versus three or more doses of intermittent preventive treatment for malaria during pregnancy in sub-Saharan Africa: a modelling study of meta-analysis and cost data