Abstract
.The recent Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance (MORDOR) trial reported a reduction in child mortality following biannual azithromycin mass drug administration (MDA). Here, we investigate the financial costs and cost-effectiveness from the health provider perspective of azithromycin MDA at the MORDOR-Malawi study site. During MORDOR, a cluster-randomized trial involving biannual azithromycin MDA or placebo to children aged 1–59 months, fieldwork-related costs were collected, including personnel, transport, consumables, overheads, training, and supervision. Mortality rates in azithromycin- and placebo-treated clusters were calculated overall and for the five health zones of Mangochi district. These were used to estimate the number needed to treat to avert one death and the costs per death and disability-adjusted life year (DALY) averted. The cost per dose of MDA was $0.74 overall, varying between $0.63 and $0.94 in the five zones. Overall, the number needed to treat to avert one death was 1,213 children; the cost per death averted was $898.47, and the cost per DALY averted was $9.98. In the three zones where mortality was lower in azithromycin-treated clusters, the number needed to treat to avert one death, cost per death averted, and cost per DALY averted, respectively, were as follows: 3,070, $2,899.24, and $32.31 in Monkey Bay zone; 1,530, $1,214.42, and $13.49 in Chilipa zone; and 344, $217.98, and $2.42 in Namwera zone. This study is a preliminary cost-effectiveness analysis that indicates azithromycin MDA for reducing child mortality has the potential to be highly cost-effective in some settings in Malawi, but the reasons for geographical variation in effectiveness require further investigation.
Highlights
Azithromycin mass drug administration (MDA) is a key part of the global campaign to eliminate blinding trachoma.[1]
Research alongside trachoma programs has indicated a beneficial effect of azithromycin MDA on child morbidity indicators,[2,3,4,5,6] and increasing evidence suggests this may include a reduction in child mortality.[7,8]
The MORDOR trial, investigating the effect of biannual azithromycin MDA to children aged 1–59 months on child mortality in Malawi, Niger, and Tanzania, reported 14% lower mortality in azithromycin- compared to placebo-treated communities.[8]
Summary
Azithromycin mass drug administration (MDA) is a key part of the global campaign to eliminate blinding trachoma.[1] Research alongside trachoma programs has indicated a beneficial effect of azithromycin MDA on child morbidity indicators,[2,3,4,5,6] and increasing evidence suggests this may include a reduction in child mortality.[7,8]. In the short term, practical, cost-effective interventions to reduce child mortality are of particular interest. Such heterogeneity raises important questions about who should be targeted and where, if wider country campaigns of azithromycin MDA to reduce child mortality are to be considered. As cost data were not collected uniformly at the three
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