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Cost-Effectiveness of Intermittent Preventive Treatment of Malaria in Pregnancy in Southern Mozambique

Author

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  • Elisa Sicuri
  • Azucena Bardají
  • Tacilta Nhampossa
  • Maria Maixenchs
  • Ariel Nhacolo
  • Delino Nhalungo
  • Pedro L Alonso
  • Clara Menéndez

Abstract

Background: Malaria in pregnancy is a public health problem for endemic countries. Economic evaluations of malaria preventive strategies in pregnancy are needed to guide health policies. Methods and Findings: This analysis was carried out in the context of a trial of malaria intermittent preventive treatment in pregnancy with sulphadoxine-pyrimethamine (IPTp-SP), where both intervention groups received an insecticide treated net through the antenatal clinic (ANC) in Mozambique. The cost-effectiveness of IPTp-SP on maternal clinical malaria and neonatal survival was estimated. Correlation and threshold analyses were undertaken to assess the main factors affecting the economic outcomes and the cut-off values beyond which the intervention is no longer cost-effective. In 2007 US$, the incremental cost-effectiveness ratio (ICER) for maternal malaria was 41.46 US$ (95% CI 20.5, 96.7) per disability-adjusted life-year (DALY) averted. The ICER per DALY averted due to the reduction in neonatal mortality was 1.08 US$ (95% CI 0.43, 3.48). The ICER including both the effect on the mother and on the newborn was 1.02 US$ (95% CI 0.42, 3.21) per DALY averted. Efficacy was the main factor affecting the economic evaluation of IPTp-SP. The intervention remained cost-effective with an increase in drug cost per dose up to 11 times in the case of maternal malaria and 183 times in the case of neonatal mortality. Conclusions: IPTp-SP was highly cost-effective for both prevention of maternal malaria and reduction of neonatal mortality in Mozambique. These findings are likely to hold for other settings where IPTp-SP is implemented through ANC visits. The intervention remained cost-effective even with a significant increase in drug and other intervention costs. Improvements in the protective efficacy of the intervention would increase its cost-effectiveness. Provision of IPTp with a more effective, although more expensive drug than SP may still remain a cost-effective public health measure to prevent malaria in pregnancy. Trial Registration: ClinicalTrials.gov NCT00209781

Suggested Citation

  • Elisa Sicuri & Azucena Bardají & Tacilta Nhampossa & Maria Maixenchs & Ariel Nhacolo & Delino Nhalungo & Pedro L Alonso & Clara Menéndez, 2010. "Cost-Effectiveness of Intermittent Preventive Treatment of Malaria in Pregnancy in Southern Mozambique," PLOS ONE, Public Library of Science, vol. 5(10), pages 1-10, October.
    • Handle: RePEc:plo:pone00:0013407
    DOI: 10.1371/journal.pone.0013407
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    References listed on IDEAS

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    1. Samuel Shillcutt & Damian Walker & Catherine Goodman & Anne Mills, 2009. "Cost Effectiveness in Low- and Middle-Income Countries," PharmacoEconomics, Springer, vol. 27(11), pages 903-917, November.
    2. World Bank, 2008. "World Development Indicators 2008," World Bank Publications - Books, The World Bank Group, number 11855, December.
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    4. Andrew H. Briggs & David E. Wonderling & Christopher Z. Mooney, 1997. "Pulling cost‐effectiveness analysis up by its bootstraps: A non‐parametric approach to confidence interval estimation," Health Economics, John Wiley & Sons, Ltd., vol. 6(4), pages 327-340, July.
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    6. World Bank, 2008. "World Development Indicators 2008," World Bank Publications - Books, The World Bank Group, number 28241, December.
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    Cited by:

    1. Benjarin Santatiwongchai & Varit Chantarastapornchit & Thomas Wilkinson & Kittiphong Thiboonboon & Waranya Rattanavipapong & Damian G Walker & Kalipso Chalkidou & Yot Teerawattananon, 2015. "Methodological Variation in Economic Evaluations Conducted in Low- and Middle-Income Countries: Information for Reference Case Development," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-15, May.
    2. Laia Cirera & Beatriz Galatas & Sergi Alonso & Krijn Paaijmans & Miler Mamuquele & Helena Martí-Soler & Caterina Guinovart & Humberto Munguambe & Fabião Luis & Hoticha Nhantumbo & Júlia Montañà & Quiq, 2020. "Moving towards malaria elimination in southern Mozambique: Cost and cost-effectiveness of mass drug administration combined with intensified malaria control," PLOS ONE, Public Library of Science, vol. 15(7), pages 1-17, July.
    3. Elisa Sicuri & Azucena Bardají & Betuel Sigauque & Maria Maixenchs & Ariel Nhacolo & Delino Nhalungo & Eusebio Macete & Pedro L Alonso & Clara Menéndez, 2011. "Costs Associated with Low Birth Weight in a Rural Area of Southern Mozambique," PLOS ONE, Public Library of Science, vol. 6(12), pages 1-9, December.
    4. Elisa Sicuri & Silke Fernandes & Eusebio Macete & Raquel González & Ghyslain Mombo-Ngoma & Achille Massougbodgi & Salim Abdulla & August Kuwawenaruwa & Abraham Katana & Meghna Desai & Michel Cot & Mic, 2015. "Economic Evaluation of an Alternative Drug to Sulfadoxine-Pyrimethamine as Intermittent Preventive Treatment of Malaria in Pregnancy," PLOS ONE, Public Library of Science, vol. 10(4), pages 1-23, April.

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