Comparative Cost-Benefit Of Antimalaria Therapy
Keywords:
Artemisinin-based Combination Therapies, Sulphadoxine-Pyrimethamine, Chloroquine, Cost-benefit, Protection PeriodAbstract
Background: Antimalaria combination therapy is the simultaneous use of two or more blood schizontocidal drugs with independent modes of action and different biochemical targets on malaria parasites. Presently, 90% of global episodes of clinical malaria and malaria mortality occur in sub-Saharan Africa. Malaria control efforts in the region were greatly affected by the emergence and spread of chloroquine (CQ) and sulfadoxine-pyrimethamine (SP) resistant plasmodium species. Artemisinin-based combination therapies (ACTs) was shown to improve treatment efficacy and curtailed drug resistance. The study aimed at comparing the post-treatment protection period as benefit with cost of procuring antimalarial drugs by consumers.
Method: The University Health Center, Uyo was selected for the study by convenience sampling. Ethical approval was obtained from the Center. Case notes of 118 patients on antimalaria prescriptions attending the Center for treatment of uncomplicated malaria from January 1st 2004 to December 31st 2013 were surveyed. Information such as age, sex, names and time of prescribed antimalarial drugs were collated. Protection period was measured by time interval between two antimalarial prescriptions. Statistical analysis was computed by using SPSS version 21 software packages. Statistical significance level was set at p=0.05.
Result: A total of one thousand three hundred and sixty-five (1365) antimalarial prescriptions were collated among patients of different age groups ranging from 0 to 79 years. Four hundred and eighty-four (484) and eight hundred eighty-one (881) antimalarial prescriptions were received by male and female patients respectively. Antimalarial single therapy (558, 40.87%) was prescribed mostly in 2004 while ACT (443, 32.45%) and other combination therapies (323, 23.66%) were used predominantly after 2004. SP (208, 37.27%) and Artemether + Lumefantrine (AL) (309, 69.75%) were the most frequently prescribed antimalarial single therapy and approved ACT respectively. The protection period of antimalarial single therapy was highest for Artesunate (233.75±31.92days). The protection period of antimalarial combination therapy approved as ACT was highest for Artesunate + Amodiaquine (AA) (192.51±24.28days).
Conclusion: This study showed that none of the recommended artemisinin-based combination therapies produced protection period as when artesunate was used alone. AA was shown to have the best cost-benefit among all the four recommended ACTs.
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