Cost-effectiveness of community-based distribution of intermittent preventive treatment of malaria in pregnancy in Madagascar, Mozambique, Nigeria, and the Democratic Republic of Congo

Bibliographic Data

ID21880133
AuthorsLaia Cirera (0000-0002-1133-487X, Barcelona Institute for Global Health, corresponding author), Charfudin Sacoor (0000-0002-8724-0319, Manhiça Health Research Centre), Martin Meremikwu (0000-0002-6144-9413, University of Calabar), Louise Ranaivo (Malagasy Associates for Numerical Information and Statistical Analysis (MANISA), Antananarivo, Madagascar), Manu F Manun’Ebo (0000-0002-7023-3876, Institut Supérieur de Statistiques de Kinshasa), Clara Pons‐Duran (0000-0002-9840-7559, Barcelona Institute for Global Health), Clara Pons-Duran (Maternal, Child and Reproductive Health Initiative, Barcelona Institute for Global Health, Barcelona, Spain), Dachi Arikpo (0000-0002-9035-9193, University of Calabar), Maximo Ramirez (Barcelona Institute for Global Health), Francesco Ramponi (0000-0002-6274-7623, Barcelona Institute for Global Health), Antía Figueroa-Romero (0000-0003-4682-1421, Barcelona Institute for Global Health), Raquel Gonzalez (0000-0001-5487-801X, Manhiça Health Research Centre), Christina Maly (0000-0002-2486-5995, Johns Hopkins University), Elaine Roman (0000-0001-8381-1885, Johns Hopkins University), Elisa Sicuri (0000-0002-2499-2732, Barcelona Institute for Global Health), Franco Pagnoni (Barcelona Institute for Global Health), Clara Menéndez (0000-0002-2641-6907, Manhiça Health Research Centre)
Year2023
Volume8
Issue7
Pagese010238
Publication date2023-07-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2022-010238
PMID37479498
OpenAlexW4385063943
LanguageEN
Citations received1
References cited37

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

Cost effectiveness · Environmental health · Malaria · Global Maternal and Child Health · Malaria Research and Control · Medicine · Parasites and Host Interactions · Immunology

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