Assessing the cost–effectiveness of prereferral rectal artesunate for treatment of severe childhood malaria

Abstract

Evaluation of: Tozan Y, Klein EY, Darley S, Panicker R, Laxminarayan R, Breman JG. Prereferral rectal artesunate for treatment of severe childhood malaria: a cost–effectiveness analysis. Lancet 376(9756), 1910–1915 (2010).Tozan and colleagues present the first detailed cost–effectiveness study of community-based prereferral artesunate treatment of children suspected of having severe malaria in areas with poor access to formal healthcare. Modeling a cohort of 1000 newborn babies up to 5 years of age, the cost–effectiveness (in 2008 international dollars [I$]) of the intervention is reported from the provider perspective. Cost–effectiveness results are presented for scenarios with low (25%), moderate (50%), high (75%) and full (100%) intervention uptake and referral compliance. At low intervention uptake and referral compliance, the intervention is estimated to avert 19 disability-adjusted life-years (DALYs; 95% CI: 16–21) and to cost I$1173 (95% CI: 1050–1297) per DALY averted. Under the full uptake and compliance scenario, the intervention averts 967 DALYs (95% CI: 884–1050) at a cost of I$77 (95% CI: 73–81) per DALY averted. Tozan and colleagues’ findings suggest that prereferral artesunate treatment is a cost-effective, life-saving intervention in rural African settings where functioning community health workers exist.