Abstract
BackgroundDespite demonstrated benefits and World Health Organization (WHO) endorsement, parenteral artesunate is the recommended treatment for patients with severe Plasmodium falciparum malaria in only one fifth of endemic countries. One possible reason for this slow uptake is that a treatment course of parenteral artesunate is costlier than quinine and might, therefore, pose a substantial economic burden to health care systems. This analysis presents a detailed account of the resources used in treating falciparum malaria by either parenteral artesunate or quinine in a hospital on the Thai-Myanmar border.MethodsThe analysis used data from four studies, with random allocation of inpatients with falciparum malaria to treatment with parenteral artesunate or quinine, conducted in Mae Sot Hospital, Thailand from 1995 to 2001. Detailed resource use data were collected during admission and unit costs from the 2008 hospital price list were applied to these. Total admission costs were broken down into five categories: 1) medication; 2) intravenous fluids; 3) disposables; 4) laboratory tests; and 5) services.ResultsWhile the medication costs were higher for patients treated with artesunate, total admission costs were similar in those treated with quinine, US$ 243 (95% CI: 167.5-349.7) and in those treated with artesunate US$ 190 (95% CI: 131.0-263.2) (P = 0.375). For cases classified as severe malaria (59%), the total cost of admission was US$ 298 (95% CI: 203.6-438.7) in the quinine group as compared with US$ 284 (95% CI: 181.3-407) in the artesunate group (P = 0.869).ConclusionThis analysis finds no evidence for a difference in total admission costs for malaria inpatients treated with artesunate as compared with quinine. Assuming this is generalizable to other settings, the higher cost of a course of artesunate should not be considered a barrier for its implementation in the treatment of malaria.
Highlights
Despite demonstrated benefits and World Health Organization (WHO) endorsement, parenteral artesunate is the recommended treatment for patients with severe Plasmodium falciparum malaria in only one fifth of endemic countries
Of all admitted malaria patients, 29 were treated with parenteral quinine and 71 by parenteral artesunate
Length of hospital stay was different in the two groups, with a mean of seven days in the quinine group as compared with four days for artesunate
Summary
Despite demonstrated benefits and World Health Organization (WHO) endorsement, parenteral artesunate is the recommended treatment for patients with severe Plasmodium falciparum malaria in only one fifth of endemic countries. One possible reason for this slow uptake is that a treatment course of parenteral artesunate is costlier than quinine and might, pose a substantial economic burden to health care systems This analysis presents a detailed account of the resources used in treating falciparum malaria by either parenteral artesunate or quinine in a hospital on the Thai-Myanmar border. Subsequent cost-effectiveness analyses confirmed the economic superiority of artesunate over quinine in the management of malaria in both the African [6] and Asian [7] settings, with an incremental cost per death averted of approximately $150 in both settings, and is highly cost-effective Despite these demonstrated benefits and WHO endorsements, parenteral artesunate is the recommended first-line treatment for patients with severe malaria in a small number of endemic and non-endemic countries, including only two countries in sub-Saharan Africa [1]. This study estimates and compares the costs of treating adult malaria inpatients in a hospital on the Thai-Myanmar border with either parenteral artesunate or quinine, building on a detailed account of the resources used in caring for these patients
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