Cost-effectiveness of sulfadoxine-pyrimethamine for the prevention of malaria-associated low birth weight.

Jul 10, 2001The American journal of tropical medicine and hygiene

Cost-effectiveness of using sulfadoxine-pyrimethamine to prevent low birth weight from malaria

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Abstract

For a hypothetical cohort of 10,000 pregnant women, the monthly sulfadoxine-pyrimethamine (SP) regimen could prevent 229 cases of low birth weight (LBW) infants associated with malaria.

Intermittent presumptive treatment with SP during pregnancy is associated with a decrease in placental malaria prevalence.
HIV-negative women benefit from two doses of SP, while HIV-positive women may require a monthly regimen to achieve similar reductions.
The two-dose SP and monthly SP regimens prevent 172 and 229 LBW cases, respectively, compared to febrile case management.
The monthly SP regimen is the most cost-effective strategy when HIV seroprevalence exceeds 10%.
At lower HIV seroprevalence rates, the two-dose SP regimen is the less expensive option.
Both presumptive treatment strategies are considered cost-effective based on antenatal clinic costs.

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Prevention of placental malaria through administration of antimalarial medications to pregnant women in disease-endemic areas decreases the risk of delivery of low birth weight (LBW) infants. In areas of high Plasmodium falciparum transmission, two intermittent presumptive treatment doses of sulfadoxine-pyrimethamine (SP) during the second and third trimesters of pregnancy are effective in decreasing the prevalence of placental malaria in human immunodeficiency virus (HlV)-negative women, while HIV-positive women may require a monthly SP regimen to reduce their prevalence of placental parasitemia. A decision-analysis model was used to compare the cost-effectiveness of three different presumptive SP treatment regimens with febrile case management with SP in terms of incremental cost per case LBW prevented. Factors considered included HIV seroprevalence, placental malaria prevalence, LBW incidence, the cost of SP, medical care for LBW infants, and HIV testing. For a hypothetical cohort of 10,000 pregnant women, the monthly SP regimen would always be the most effective strategy for reducing LBW associated with malaria. The two-dose SP and monthly SP regimens would prevent 172 and 229 cases of LBW, respectively, compared with the case management approach. At HIV seroprevalence rates greater than 10%, the monthly SP regimen is the least expensive strategy. At HIV seroprevalence rates less than 10%, the two-dose SP regimen would be the less expensive option. When only antenatal clinic costs are considered, the two-dose and monthly SP strategies cost US $11 and $14, respectively, well within the range considered cost effective. Presumptive treatment regimens to prevent LBW associated with malaria and the subsequent increased risk of mortality during the first year of life are effective and cost effective strategies in areas with both elevated HIV prevalence and malaria transmission rates.

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Cost-effectiveness of sulfadoxine-pyrimethamine for the prevention of malaria-associated low birth weight.

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