Cost-effectiveness of community-based distribution of intermittent preventive treatment of malaria in pregnancy in Madagascar, Mozambique, Nigeria, and the Democratic Republic of Congo

Cirera, Laia, Sacoor, Charfudin, Meremikwu, Martin, Ranaivo, Louise, Manun'ebo, Manu F., Pons-Duran, Clara, Arikpo, Dachi, Ramirez, Maximo, Ramponi, Francesco, Figueroa-Romero, Antia, Gonzalez, Raquel, Maly, Christina, Roman, Elaine, Sicuri, Elisa ORCID: 0000-0002-2499-2732, Pagnoni, Franco and Menéndez, Clara (2023) Cost-effectiveness of community-based distribution of intermittent preventive treatment of malaria in pregnancy in Madagascar, Mozambique, Nigeria, and the Democratic Republic of Congo. BMJ Global Health, 8 (7). ISSN 2059-7908

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Abstract

Introduction Malaria in pregnancy is a major driver of maternal and infant mortality in sub-Saharan Africa. The WHO recommends the administration of intermittent preventive treatment with sulfadoxine pyrimethamine (IPTp-SP) at antenatal care (ANC) visits. Despite being a highly cost-effective strategy, IPTp-SP coverage and uptake remains low. A pilot project was conducted to assess the cost-effectiveness (CE) of community-based delivery of IPTp (C-IPTp) in addition to ANC delivery to increase IPTp uptake in the Democratic Republic of Congo (DRC), Madagascar (MDG), Mozambique (MOZ) and Nigeria (NGA). Methods Costs and CE estimates of C-IPTp were calculated according to two scenarios: (1) costs in 'programmatic mode' (ie, costs if C-IPTp was to be implemented by national health systems) and (2) costs from the pilot project. The effectiveness of C-IPTp was obtained through estimates of the averted disability-adjusted life-years (DALYs) associated with maternal clinical malaria and anaemia, low birth weight and neonatal mortality. Results Net incremental costs of C-IPTp ranged between US$6138-US$47 177 (DRC), US$5552-US$31 552 (MDG), US$10 202-US$53 221 (MOZ) and US$667-US$28 645 (NGA) per 1000 pregnant women, under scenarios (1) and (2), respectively. Incremental cost-effectiveness ratios (ICERs) ranged between US$15-US$119 in DRC, US$9-US$53 in MDG, US$104-US$543 in MOZ and US$2-US$66 in NGA per DALY averted, under scenarios (1) and (2), respectively. ICERs fall below the WHO recommended CE threshold based on the gross domestic product per capita. Conclusion Findings suggest that C-IPTp is a highly cost-effective intervention. Results can inform policy decisions on adopting and optimising effective interventions for preventing malaria in pregnancy.

Item Type:	Article
Official URL:	https://gh.bmj.com/
Additional Information:	© 2023 The Authors
Divisions:	Health Policy
Subjects:	R Medicine > RA Public aspects of medicine R Medicine > RG Gynecology and obstetrics R Medicine > RM Therapeutics. Pharmacology
Date Deposited:	16 Aug 2023 08:15
Last Modified:	25 Apr 2024 20:48
URI:	http://eprints.lse.ac.uk/id/eprint/119991

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