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 |
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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: | 12 Dec 2024 03:50 |
URI: | http://eprints.lse.ac.uk/id/eprint/119991 |
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