Cost-effectiveness of pre-referral antimalarial, antibacterial, and combined rectal formulations for severe XXXX .

@entity311 @entity221 @entity204 @entity2348
BACKGROUND: @entity311 and @entity2348 account for most @entity204 in developing countries. Prompt treatment saves lives, but rapid deterioration often prevents the use of oral therapies; delays in reaching health facilities providing parenteral interventions are common. Rapidly and reliably absorbed antimalarial/antibacterial rectal formulations used in the community could prevent @entity204 and disabilities. Rectal antimalarial treatments are currently available; rectal antibacterial treatments are yet to be developed. Assessment of the likely cost-effectiveness of these interventions will inform research priorities and implementation. METHODS AND FINDINGS: The burden of @entity311 and @entity2348 worldwide and in Sub-Saharan and Southern Africa (SSA) and South and South-East Asia (SEA) was summarised using published data. The additional healthcare costs (US ) per @entity204 and per Disability Adjusted Life Year (DALY) avoided following pre-referral treatment of severe @entity221 with rectal antimalarials, antibacterials or combined antimalarial/antibacterials in populations at @entity311 risk in SSA/SEA were assessed. 46 million severe @entity311 and @entity2348 and 5 million @entity204 occur worldwide each year, mostly in SSA/SEA. At annual delivery costs of  0.02/capita and 100% coverage, rectal antimalarials ( 2 per dose) would avert 240,000 @entity204 in SSA and 7,000 @entity204 in SEA at  5 and  177 per DALY avoided, respectively; rectal antibacterials ( 2 per dose) would avert 130,000 @entity204 in SSA and 27,000 @entity204 in SEA at  19 and  97 per DALY avoided, respectively. Combined rectal formulations ( 2.50 per dose) would avert 370,000 @entity204 in SSA and 33,000 @entity204 in SEA at  8 and  79 per DALY avoided, respectively, and are a cost-effective alternative to rectal antimalarials or antibacterials alone. CONCLUSIONS: Antimalarial, antibacterial and combined rectal formulations are likely to be cost-effective interventions for severe @entity221 in the community. Attention should focus on developing effective rectal antibacterials and ensuring that these lifesaving treatments are used in a cost-effective manner.
