Assessment of the Cost Effectiveness of Pre-Referral Malaria Treatments Using Decision Analytic Modeling
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Background: Mortality due to malaria occurs mostly in children aged below five years in Sub-Saharan Africa region because of its high malaria endemicity with majority of at risk people living in resource poor, hard to reach rural areas with limited access to healthcare. Pre-referral antimalarial treatment seeks to combat the delay in access and the progress of severe malaria that contributes to mortality. Though pre-referral rectal artesunate has been included in the Kenyan National guidelines for treatment of malaria, its cost effectiveness has not been compared to current parenteral treatments in the Kenyan setting.

Objective: The main objective of the study is to compare the cost-effectiveness of rectal artesunate versus intramuscular quinine, intramuscular artesunate and no pre-referral treatment.

Method: A qualitative cross-sectional study that will be conducted through key informant interviews. This study will seek to establish the program costs involved in acquisition and implementation of pre-referral treatments. We will also carry out a cost utility study from the provider perspective which will include capital costs of implementation and the recurrent costs of running the program. This study will focus on a theoretical cohort of 1000 children aged less than five years who live in rural hard to reach resource poor areas and it will cover a five year period. We will assess the cost-effectiveness (in Kenyan shillings) of the interventions using DALYs as the key measure of effectiveness. Sensitivity analysis will be done to assess the impact of uncertainties in costs and effectiveness for the cost utility study, while a best and worst-case scenario analysis will be done for the qualitative study.

Expected benefits

This study will help the government and other stakeholders to assess the short term and long term cost and benefits of pre-referral antimalarial treatment. This may influence the decision whether to implement the use of pre-rectal artesunate as indicated in the National Guidelines for Treatment of Malaria.