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Modelling the cost-effectiveness of mass screening and treatment for reducing Plasmodium falciparum malaria burden
BACKGROUND: Past experience and modelling suggest that, in most cases, mass treatment strategies are not likely to succeed in interrupting Plasmodium falciparum malaria transmission. However, this does not preclude their use to reduce disease burden. Mass screening and treatment (MSAT) is preferred...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544609/ https://www.ncbi.nlm.nih.gov/pubmed/23286228 http://dx.doi.org/10.1186/1475-2875-12-4 |
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author | Crowell, Valerie Briët, Olivier JT Hardy, Diggory Chitnis, Nakul Maire, Nicolas Pasquale, Aurelio Di Smith, Thomas A |
author_facet | Crowell, Valerie Briët, Olivier JT Hardy, Diggory Chitnis, Nakul Maire, Nicolas Pasquale, Aurelio Di Smith, Thomas A |
author_sort | Crowell, Valerie |
collection | PubMed |
description | BACKGROUND: Past experience and modelling suggest that, in most cases, mass treatment strategies are not likely to succeed in interrupting Plasmodium falciparum malaria transmission. However, this does not preclude their use to reduce disease burden. Mass screening and treatment (MSAT) is preferred to mass drug administration (MDA), as the latter involves massive over-use of drugs. This paper reports simulations of the incremental cost-effectiveness of well-conducted MSAT campaigns as a strategy for P. falciparum malaria disease-burden reduction in settings with varying receptivity (ability of the combined vector population in a setting to transmit disease) and access to case management. METHODS: MSAT incremental cost-effectiveness ratios (ICERs) were estimated in different sub-Saharan African settings using simulation models of the dynamics of malaria and a literature-based MSAT cost estimate. Imported infections were simulated at a rate of two per 1,000 population per annum. These estimates were compared to the ICERs of scaling up case management or insecticide-treated net (ITN) coverage in each baseline health system, in the absence of MSAT. RESULTS: MSAT averted most episodes, and resulted in the lowest ICERs, in settings with a moderate level of disease burden. At a low pre-intervention entomological inoculation rate (EIR) of two infectious bites per adult per annum (IBPAPA) MSAT was never more cost-effective than scaling up ITNs or case management coverage. However, at pre-intervention entomological inoculation rates (EIRs) of 20 and 50 IBPAPA and ITN coverage levels of 40 or 60%, respectively, the ICER of MSAT was similar to that of scaling up ITN coverage further. CONCLUSIONS: In all the transmission settings considered, achieving a minimal level of ITN coverage is a “best buy”. At low transmission, MSAT probably is not worth considering. Instead, MSAT may be suitable at medium to high levels of transmission and at moderate ITN coverage. If undertaken as a burden-reducing intervention, MSAT should be continued indefinitely and should complement, not replace, case management and vector control interventions. |
format | Online Article Text |
id | pubmed-3544609 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-35446092013-01-16 Modelling the cost-effectiveness of mass screening and treatment for reducing Plasmodium falciparum malaria burden Crowell, Valerie Briët, Olivier JT Hardy, Diggory Chitnis, Nakul Maire, Nicolas Pasquale, Aurelio Di Smith, Thomas A Malar J Research BACKGROUND: Past experience and modelling suggest that, in most cases, mass treatment strategies are not likely to succeed in interrupting Plasmodium falciparum malaria transmission. However, this does not preclude their use to reduce disease burden. Mass screening and treatment (MSAT) is preferred to mass drug administration (MDA), as the latter involves massive over-use of drugs. This paper reports simulations of the incremental cost-effectiveness of well-conducted MSAT campaigns as a strategy for P. falciparum malaria disease-burden reduction in settings with varying receptivity (ability of the combined vector population in a setting to transmit disease) and access to case management. METHODS: MSAT incremental cost-effectiveness ratios (ICERs) were estimated in different sub-Saharan African settings using simulation models of the dynamics of malaria and a literature-based MSAT cost estimate. Imported infections were simulated at a rate of two per 1,000 population per annum. These estimates were compared to the ICERs of scaling up case management or insecticide-treated net (ITN) coverage in each baseline health system, in the absence of MSAT. RESULTS: MSAT averted most episodes, and resulted in the lowest ICERs, in settings with a moderate level of disease burden. At a low pre-intervention entomological inoculation rate (EIR) of two infectious bites per adult per annum (IBPAPA) MSAT was never more cost-effective than scaling up ITNs or case management coverage. However, at pre-intervention entomological inoculation rates (EIRs) of 20 and 50 IBPAPA and ITN coverage levels of 40 or 60%, respectively, the ICER of MSAT was similar to that of scaling up ITN coverage further. CONCLUSIONS: In all the transmission settings considered, achieving a minimal level of ITN coverage is a “best buy”. At low transmission, MSAT probably is not worth considering. Instead, MSAT may be suitable at medium to high levels of transmission and at moderate ITN coverage. If undertaken as a burden-reducing intervention, MSAT should be continued indefinitely and should complement, not replace, case management and vector control interventions. BioMed Central 2013-01-03 /pmc/articles/PMC3544609/ /pubmed/23286228 http://dx.doi.org/10.1186/1475-2875-12-4 Text en Copyright ©2013 Crowell et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Crowell, Valerie Briët, Olivier JT Hardy, Diggory Chitnis, Nakul Maire, Nicolas Pasquale, Aurelio Di Smith, Thomas A Modelling the cost-effectiveness of mass screening and treatment for reducing Plasmodium falciparum malaria burden |
title | Modelling the cost-effectiveness of mass screening and treatment for reducing Plasmodium falciparum malaria burden |
title_full | Modelling the cost-effectiveness of mass screening and treatment for reducing Plasmodium falciparum malaria burden |
title_fullStr | Modelling the cost-effectiveness of mass screening and treatment for reducing Plasmodium falciparum malaria burden |
title_full_unstemmed | Modelling the cost-effectiveness of mass screening and treatment for reducing Plasmodium falciparum malaria burden |
title_short | Modelling the cost-effectiveness of mass screening and treatment for reducing Plasmodium falciparum malaria burden |
title_sort | modelling the cost-effectiveness of mass screening and treatment for reducing plasmodium falciparum malaria burden |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544609/ https://www.ncbi.nlm.nih.gov/pubmed/23286228 http://dx.doi.org/10.1186/1475-2875-12-4 |
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