Saving Lives, Buying Time Economics of Malaria Drugs in an Age of Resistance (2004) / Chapter Skim
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2 The Cost and Cost-Effectiveness of Antimalarial Drugs
2 The Cost and Cost-Effectiveness of Antimalarial Drugs
Pages 61-78
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From page 61... ...
Even 10 cents is too much for the poorest of the poor in every endemic country (which equals substantial numbers of 1The rationale for combining two or more drugs is that doing so dramatically reduces the odds that malaria strains resistant to any of the drugs in the combination would survive to be transmitted. In this report, ACT is used mainly to describe a drug "coformulation" (i.e., two drugs in one pill)
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From page 62... ...
. These prices reflect the production costs of artemisinins without a premium for any exclusivity related to patents.3 They are high because the process involves growing the source plant, Artemisia annua, extracting the active moiety, and creating the desired artemisinin derivative (artesunate, artemether, etc.)
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From page 63... ...
Drug Range of prices for standard adult course Artesunate Asian suppliers: · US$0.50 (not yet in production) ; less for greater quantities · US$0.63; 15% discount for greater than 1 million treatments · US$1.25 (not yet in production)
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From page 64... ...
Currently, treatment failures account for some number of treatments, and these should be reduced with effective drugs, balancing out some of the incremental increases. In the lower transmission areas at least, if used optimally, ACTs have the potential to decrease malaria transmission, and therefore the volume of drugs required, as has occurred in KwaZulu Natal, South Africa, as part of an integrated control program.
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From page 65... ...
The day of the ten cent course of antimalarials may be gone, but newer, effective combination treatments still will be a relative bargain. Another thing that is not likely to change quickly, however, is the inability of the endemic countries to absorb the higher costs.
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From page 66... ...
Thus drugs must compete for both public and private funds on grounds of their value for the dollars spent: their cost-effectiveness. The question most relevant to this study is the cost-effectiveness of treating versus not treating acute episodes of malaria (the latter includes using an ineffective drug as well as no treatment)
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From page 67... ...
It also incorporates the effects of partial coverage within a population. Neither analysis attempts to model large-scale spatial effects if certain countries adopted effective antimalarials but others did not.
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From page 68... ...
As time goes on, costs increase (because of the cost of re-treating initial failures) and benefits decrease.
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From page 69... ...
Most of the assumptions were taken from a cost-effectiveness analysis of a range of malaria control methods (Good man et al., 2000) .b Cost figures (in US$)
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From page 70... ...
averted for each death avoided by treatment. This is roughly the difference between dying from the episode and living out an average lifespan, plus a small number of years lived with a disability for those who would have had long-term neurological effects from severe malaria.
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From page 71... ...
Other direct costs to the patient (or family) , including transportation, and indirect costs (lost wages)
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From page 72... ...
Leaving resistance out of the model means possibly overestimating the cost-effectiveness of ACTs in the long term, but it may still be realistic in the short and medium term. One Change versus Two: Chloroquine ACTs versus Chloroquine "Intermediate" ACTs ACTs are recommended by WHO as the drug of choice for policy change in countries with significant chloroquine resistance.
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From page 73... ...
At high levels of treatment coverage (and high drug pressure) , resistance evolves so rapidly regardless of which strategy is followed that the faster acquisition of immunity with a less effective drug plays a critical role in determining the superior strategy.
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From page 74... ...
People must gain collective experience with a new drug, and observe its effects consistently to make the change complete, which can take years. This model does not incorporate policy change costs or other difficulties, so it may mask a portion of the true costs of switching first to an intermediate antimalarial and then to ACTs, versus a single switch to ACTs.
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From page 75... ...
Funds deployed by governments come from internal country resources as well as from the major donors of development assistance, including support from individual countries (bilateral aid) , and from international organizations, most importantly, the International Development Association of the World Bank, and other United Nations agencies.
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From page 76... ...
Development partners also were called upon to cancel the debt of poor and heavily indebted nations so that more resources could be released to address malaria and otherwise alleviate poverty. In addition, the Abuja summit sought resources to support R&D for the whole range of malaria control measures.
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From page 77... ...
. The costs included in these estimates are basically the local cost of the interventions, their delivery, and local management support, but not of broader health sector improvements that would be needed to make them possible.
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From page 78... ...
1978. Changing patterns in the humoral immune response to malaria before, during, and after the application of control measures: A longitudinal study in the West African savanna.
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