Cost-effectiveness of three malaria treatment strategies in rural Tigray, Ethiopia where both Plasmodium falciparum and Plasmodium vivax co-dominate

被引：18

作者：

Lemma H. ^{[1
]}

San Sebastian M. ^{[2
]}

Löfgren C. ^{[2
]}

Barnabas G. ^{[1
]}

机构：

[1] Tigray Health Bureau, Mekelle

[2] Umeå International School of Public Health, Dept of Public Health and Clinical Medicine, Umeå University

来源：

Cost Effectiveness and Resource Allocation | / 9卷 / 1期

关键词：

Malaria; Malaria Transmission; Antimalarial Drug; Health Post; Health Extension Worker;

D O I：

10.1186/1478-7547-9-2

中图分类号：

学科分类号：

摘要：

Background: Malaria transmission in Ethiopia is unstable and the disease is a major public health problem. Both, p.falciparum (60%) and p.vivax (40%) co-dominantly exist. The national guideline recommends three different diagnosis and treatment strategies at health post level: i) the use of a p.falciparum/vivax specific RDT as diagnosis tool and to treat with artemether-lumefantrine (AL), chloroquine (CQ) or referral if the patient was diagnosed with p.falciparum, p.vivax or no malaria, respectively (parascreen pan/pf based strategy); ii) the use of a p.falciparum specific RDT and AL for p.falciparum cases and CQ for the rest (paracheck pf based strategy); and iii) the use of AL for all cases diagnosed presumptively as malaria (presumptive based strategy). This study aimed to assess the cost-effectiveness of the recommended three diagnosis and treatment strategies in the Tigray region of Ethiopia.Methods: The study was conducted under a routine health service delivery following the national malaria diagnosis and treatment guideline. Every suspected malaria case, who presented to a health extension worker either at a village or health post, was included. Costing, from the provider's perspective, only included diagnosis and antimalarial drugs. Effectiveness was measured by the number of correctly treated cases (CTC) and average and incremental cost-effectiveness calculated. One-way and two-way sensitivity analyses were conducted for selected parameters.Results: In total 2,422 subjects and 35 health posts were enrolled in the study. The average cost-effectiveness ratio showed that the parascreen pan/pf based strategy was more cost-effective (US$1.69/CTC) than both the paracheck pf (US$4.66/CTC) and the presumptive (US$11.08/CTC) based strategies. The incremental cost for the parascreen pan/pf based strategy was US$0.59/CTC to manage 65% more cases. The sensitivity analysis also confirmed parascreen pan/pf based strategy as the most cost-effective.Conclusion: This study showed that the parascreen pan/pf based strategy should be the preferred option to be used at health post level in rural Tigray. This finding is relevant nationwide as the entire country's malaria epidemiology is similar to the study area. © 2011 Lemma et al; licensee BioMed Central Ltd.

引用

共 35 条

[1]

World Malaria Report 2008, (2008)

[2]

Global Malaria Action Plan for a malaria-free world, (2009)

[3]

National five-years strategic plan for malaria prevention & control in Ethiopia, 2006-2010, (2006)

[4]

Otten M., Aregawi M., Were W., Karema C., Medin A., Bekele W., Jima D., Gausi K., Komatsu R., Korenromp E., Low-Beer D., Grabowsky M., Initial evidence of reduction of malaria cases and deaths in Rwanda and Ethiopia due to rapid scale-up of malaria prevention and treatment, Malar J, 8, (2009)

[5]

Deressa W., Ali A., Enqusellassie F., Self-treatment of malaria in rural communities, Butajira, southern Ethiopia, Bull World Health Organ, 81, 4, pp. 261-268, (2003)

[6]

Ghebreyesus T.A., Witten K.H., Getachew A., Yohannes A.M., Tesfay W., Minass M., Bosman A., Teklehaimanot A., The community-based malaria control programme in Tigray, northern Ethiopia. A review of programme set-up, activities, outcomes and impact, Parassitologia, 42, 3-4, pp. 255-290, (2000)

[7]

Antimalarial drug combination therapy, (2001)

[8]

Malaria diagnosis and treatment guideline for health workers in Ethiopia, 2nd edition, (2004)

[9]

Health Extension Programme-Major training packages

[10]

San Sebastian M., Lemma H., Efficiency of the health extension programme in Tigray, Ethiopia: a data envelopment analysis, BMC Int Health Hum Rights, 10, (2010)

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