Cost-effectiveness of two versus three or more doses of intermittent preventive treatment for XXXX during pregnancy in sub-Saharan Africa: a modelling study of meta-analysis and cost data.

@entity1 @entity1484 @entity417 @entity9230 @entity645 @entity311 @entity4765
BACKGROUND: In 2012, WHO changed its recommendation for intermittent preventive treatment of @entity311 during pregnancy (IPTp) from two doses to monthly doses of @entity9230 - @entity4765 during the second and third trimesters, but noted the importance of a cost-effectiveness analysis to lend support to the decision of policy makers. We therefore estimated the incremental cost-effectiveness of IPTp with three or more (IPTp-SP3+) versus two doses of @entity1484 (IPTp-SP2). METHODS: For this analysis, we used data from a 2013 meta-analysis of seven studies in sub-Saharan Africa. We developed a decision tree model with a lifetime horizon. We analysed the base case from a societal perspective. We did deterministic and probabilistic sensitivity analyses with appropriate parameter ranges and distributions for settings with low, moderate, and high background risk of low birthweight, and did a separate analysis for @entity645 -negative @entity1 . Parameters in the model were obtained for all countries included in the original meta-analysis. We did simulations in hypothetical cohorts of 1000 pregnant @entity1 receiving either IPTp-SP3+ or IPTp-SP2. We calculated disability-adjusted life-years (DALYs) for low birthweight, severe to moderate @entity417 , and clinical @entity311 . We calculated cost estimates from data obtained in observational studies, exit surveys, and from public procurement databases. We give financial and economic costs in constant 2012 US . The main outcome measure was the incremental cost per DALY averted. FINDINGS: The delivery of IPTp-SP3+ to 1000 pregnant @entity1 averted 113  4 DALYs at an incremental cost of  825  67 producing an incremental cost-effectiveness ratio (ICER) of  7  28 per DALY averted. The results remained robust in the deterministic sensitivity analysis. In the probabilistic sensitivity analyses, the ICER was  7  7 per DALY averted for moderate risk of low birthweight,  19  4 per DALY averted for low risk, and  4  0 per DALY averted for high risk. The ICER for @entity645 -negative @entity1 was  6  2 per DALY averted. INTERPRETATION: Our findings lend strong support to the WHO guidelines that recommend a monthly dose of IPTp-SP from the second trimester onwards. FUNDING: Malaria in Pregnancy Consortium and the Bill _ Melinda Gates Foundation.
