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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...

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Autores principales: Crowell, Valerie, Briët, Olivier JT, Hardy, Diggory, Chitnis, Nakul, Maire, Nicolas, Pasquale, Aurelio Di, Smith, Thomas A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
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.
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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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