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Cost-effectiveness of intermittent preventive treatment with dihydroartemisinin-piperaquine vs single screening and treatment for the control of malaria in pregnancy in Papua, Indonesia: A provider perspective analysis from a cluster-randomized trial

The Lancet Global Health Nov 23, 2020

Paintain L, Hill J, Ahmed R, et al. - Researchers sought to determine the incremental cost-effectiveness of intermittent preventive treatment with dihydroartemisinin-piperaquine vs single screening and treatment with dihydroartemisinin-piperaquine. In this provider perspective analysis, they analyzed a decision tree model from a health provider perspective over a lifetime horizon. Deterministic and probabilistic sensitivity analyses were done using model parameters. In hypothetical cohorts of 1,000 women who were provided intermittent preventive treatment or single screening and treatment, simulations were run. In comparison with single screening and treatment, intermittent preventive treatment led to an incremental cost of US$ 5,657 and 107·4 incremental DALYs averted per 1,000 women. Per estimates, the average incremental cost-effectiveness ratio was $53 per DALY averted. Overall findings suggest that for the prevention of the adverse effects of malaria infection in pregnancy, intermittent preventive treatment with dihydroartemisinin-piperaquine is a cost-effective alternative to single screening and treatment in the context of the moderate malaria transmission setting of Papua. Monthly administration drove the higher cost of intermittent preventive treatment, as compared with single-administration single screening and treatment. However, there will also be a necessity for acceptability and feasibility considerations in order to inform decision making.

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