Changing the first line drug for malaria treatment--cost-effectiveness analysis with highly uncertain inter-temporal trade-offs


Goodman, CA; Coleman, PG; Mills, AJ; (2001) Changing the first line drug for malaria treatment--cost-effectiveness analysis with highly uncertain inter-temporal trade-offs. Health economics, 10 (8). pp. 731-49. ISSN 1057-9230 DOI: 10.1002/hec.621

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Abstract

Access to effective treatment would substantially reduce the burden of malaria in sub-Saharan Africa, but resistance to chloroquine, the most commonly used first line drug, is now widespread. There has been considerable debate over the level of chloroquine resistance at which a new first line drug should be adopted. Two issues make this an extremely complex decision: it involves trade-offs in costs and health outcomes over time; and many of the parameters are uncertain. A modelling approach was identified as appropriate for addressing these issues. The costs and effects of changing from chloroquine to sulphadoxine-pyrimethamine (SP) as the first line drug were modelled over 10 years, allowing for growth in drug resistance. Probabilistic sensitivity analysis was used to allow for the high levels of parameter uncertainty. The optimal year of switch was highly dependent on both empirical values, such as initial resistance and resistance growth rates, and on subjective values, such as the time preferences of policy-makers. It was not possible to provide policy-makers with a definitive threshold resistance level at which to switch, but the model can be used as an analytical tool to structure the problem, explore trade-offs, and identify areas for which data are lacking.

Item Type: Article
Keywords: Africa South of the Sahara, Antimalarials/*economics/*therapeutic use, Case Management, Child, Child, Preschool, Chloroquine/*economics/*therapeutic use, Comparative Study, *Cost-Benefit Analysis, Decision Trees, Drug Combinations, Drug Costs/*statistics & numerical data, Drug Resistance, Drugs, Essential/economics/supply & distribution, Health Policy, Human, Malaria/*drug therapy/*economics, *Models, Econometric, Patient Compliance, Pyrimethamine/*economics/*therapeutic use, Quality-Adjusted Life Years, Sulfadoxine/*economics/*therapeutic use, Support, Non-U.S. Gov't, Africa South of the Sahara, Antimalarials, economics, therapeutic use, Case Management, Child, Child, Preschool, Chloroquine, economics, therapeutic use, Comparative Study, Cost-Benefit Analysis, Decision Trees, Drug Combinations, Drug Costs, statistics & numerical data, Drug Resistance, Drugs, Essential, economics, supply & distribution, Health Policy, Human, Malaria, drug therapy, economics, Models, Econometric, Patient Compliance, Pyrimethamine, economics, therapeutic use, Quality-Adjusted Life Years, Sulfadoxine, economics, therapeutic use, Support, Non-U.S. Gov't
Faculty and Department: Academic Services & Administration > Academic Administration
Faculty of Public Health and Policy > Dept of Global Health and Development
Faculty of Infectious and Tropical Diseases > Dept of Disease Control
Research Centre: Malaria Centre
Antimicrobial Resistance Centre (AMR)
PubMed ID: 11747054
Web of Science ID: 173064700004
URI: http://researchonline.lshtm.ac.uk/id/eprint/16357

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