Treating malaria saves money and saves young lives

Young children in sub-Saharan Africa often become severely anemic as a result of malaria infection. Their treatment requires blood transfusions and they must stay in the hospital for several days. They are at relatively high risk of dying during treatment, but the risk is even higher in the months after they are discharged from hospital – usually from another malaria infection.

An international group of researchers from Africa, Europe and the United States recently showed that giving children prophylactic antimalarial drugs (PDMC) during these months lead to a 70% reduction in readmissions and deaths among these children. In the 20 African countries with the highest malaria burden, 36,000 readmissions could be prevented each year if all children with severe anemia received antimalarial drugs after discharge. This team led by the University of Bergen wanted to find out if this preventive treatment is cost-effective for the health sectors of Malawi, Kenya and Uganda, where malaria is endemic.

Using data from medical trials they recently conducted in these countries, the researchers developed health economic models for each country. They found that the introduction of PDMC was likely to be a cost-effective intervention in every setting, and the main reason for this was that treatment and re-hospitalization costs were much higher than simple and affordable antimalarial treatment.

“The reduction in readmissions is so significant that it’s really simple: with PDMC, you can save money while improving the health of these children,” says UiB Faculty of Medicine Professor Bjarne Roberstad. He directed the research.

His colleague Melf Kühl notes that the real strength of the study, however, lies in examining the performance of economic models. Parents sometimes forget to give the pills to their children, which significantly reduces the effect. Although often overlooked in research, this loss of efficacy is a real-life problem and may, in effect, render the initially optimal treatment no longer a cost-effective option.

So the team tested how many pills parents might forget when they were given antimalarial drugs in two different ways, and incorporated those results into each country’s model. Even so, PDMC remains “no problem”: a cost-effective option for both health care sector and home – this is when parents receive all the pills with instructions, as the child is discharged from the hospital. Asking parents regular returns to the hospital for pill refills entail higher costs for households and less real prevention effect. However, in all countries, both PDMC delivery options remained superior to the standard of care.

Based on these studies, the World Health Organization recently began recommending PDMC as a treatment for severely anemic children in malaria-endemic areas. A cost-effectiveness study informed this recommendation. More importantly, it continues to inform national decision-makers in sub-Saharan Africa who are currently debating how best to implement PDMC. Parental commitment to preventive therapy remains a largely unexplored issue, even though it provides essential information for sound policy advice. This study offers a methodological avenue for future research to incorporate real-world conservation measures into economic evaluations.

The study was published in electronic clinical medicine.