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  • Title: Antimalarials during pregnancy: a cost-effectiveness analysis.
    Author: Schultz LJ, Steketee RW, Chitsulo L, Wirima JJ.
    Journal: Bull World Health Organ; 1995; 73(2):207-14. PubMed ID: 7743592.
    Abstract:
    Antenatal clinics (ANC) provide an avenue for interventions that promote maternal and infant health. In areas hyperendemic for Plasmodium falciparum, malaria infection during pregnancy contributes to low birth weight (LBW), which is the greatest risk factor for neonatal mortality. Using current data and costs from studies in Malawi, a decision-analysis model was constructed to predict the number of LBW cases prevented by three antimalarial regimens, in an area with a high prevalence of chloroquine (CQ)-resistant malaria. Factors considered included local costs of antimalarials, number of ANC visits, compliance with dispensed antimalarials, prevalence of placental malaria, and LBW incidence. For a hypothetical cohort of 10,000 women in their first or second pregnancy, a regimen consisting of one dose of sulfadoxine-pyrimethamine (SP) in the second trimester followed by a second dose at the beginning of the third trimester would prevent 205 cases of LBW at a cost of US$ 9.66 per case of LBW prevented. A regimen using a treatment dose of SP followed by CQ 300 mg (base) weekly would prevent 59 cases of LBW at a cost of $62 per case prevented, compared with only 30 cases of LBW prevented at a cost of $113 per case when the regimen involves initial treatment with CQ (25 mg/kg) followed by CQ 300 mg (base) weekly. In areas hyperendemic for CQ-resistant P. falciparum, a two-dose SP regimen is a cost-effective intervention to reduce LBW incidence and it should be included as part of the antenatal care package. Antenatal clinics (ANC) provide an avenue for interventions that promote maternal and infant health. In areas hyperendemic for Plasmodium falciparum, malaria infection during pregnancy contributes to low birth weight (LBW), which is the greatest risk factor for neonatal mortality. Using current data and costs from studies in Malawi, a decision-analysis model was constructed to predict the number of LBW cases prevented by 3 antimalarial regimens in an area with a high prevalence of chloroquine (CQ)-resistant malaria. Factors considered included local costs of antimalarials, number of ANC visits, compliance with dispensed antimalarials, prevalence of placental malaria, and LBW incidence. For a hypothetical cohort of 10,000 women in their 1st or 2nd pregnancy, a regimen consisting of 1 dose of 1500 mg sulfadoxine and 75 mg pyrimethamine (SP) in the 2nd trimester followed by a 2nd dose at the beginning of the 3rd trimester would prevent 205 cases of LBW at a cost of US $9.66 per case of LBW prevented. A regimen using a treatment dose of SP followed by CQ (300 mg base) weekly until delivery would prevent 59 cases of LBW at a cost of $62 per case prevented, compared with only 30 cases of LBW prevented at a cost of $113 per case when the regimen involves initial treatment with CQ (25 mg/kg over 3 days) followed by CQ (300 mg base) weekly until delivery. 38% of women not attending prenatal care and not receiving antimalarials during pregnancy would have placental malaria infections at delivery. When compliance with the administration of antimalarials was ensured, 9% of the women who received SP/SP, 26% of those who received SP/CQ, and 32% of those who received CQ/CA had placental malaria infection at delivery. In areas hyperendemic for CQ-resistant P. falciparum, a 2-dose SP regimen is a cost-effective intervention to reduce LBW incidence and it should be included as part of the antenatal care package.
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