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. 2011 May 17:10:130.
doi: 10.1186/1475-2875-10-130.

Cost risk benefit analysis to support chemoprophylaxis policy for travellers to malaria endemic countries

Eduardo Massad  1 , Ben C Behrens, Francisco A B Coutinho, Ronald H Behrens
Affiliations

Cost risk benefit analysis to support chemoprophylaxis policy for travellers to malaria endemic countries

Eduardo Massad et al. Malar J. .

Abstract

Background: In a number of malaria endemic regions, tourists and travellers face a declining risk of travel associated malaria, in part due to successful malaria control. Many millions of visitors to these regions are recommended, via national and international policy, to use chemoprophylaxis which has a well recognized morbidity profile. To evaluate whether current malaria chemo-prophylactic policy for travellers is cost effective when adjusted for endemic transmission risk and duration of exposure. a framework, based on partial cost-benefit analysis was used.

Methods: Using a three component model combining a probability component, a cost component and a malaria risk component, the study estimated health costs avoided through use of chemoprophylaxis and costs of disease prevention (including adverse events and pre-travel advice for visits to five popular high and low malaria endemic regions) and malaria transmission risk using imported malaria cases and numbers of travellers to malarious countries. By calculating the minimal threshold malaria risk below which the economic costs of chemoprophylaxis are greater than the avoided health costs we were able to identify the point at which chemoprophylaxis would be economically rational.

Results: The threshold incidence at which malaria chemoprophylaxis policy becomes cost effective for UK travellers is an accumulated risk of 1.13% assuming a given set of cost parameters. The period a travellers need to remain exposed to achieve this accumulated risk varied from 30 to more than 365 days, depending on the regions intensity of malaria transmission.

Conclusions: The cost-benefit analysis identified that chemoprophylaxis use was not a cost-effective policy for travellers to Thailand or the Amazon region of Brazil, but was cost-effective for travel to West Africa and for those staying longer than 45 days in India and Indonesia.

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Figures

Figure 1
Figure 1
Probability space for the Treated (a) individual and non-treated (b)individuals.
Figure 2
Figure 2
Risk of acquiring malaria for travellers to the Brazilian Amazon region as a function of the time spent in the area. Travellers are assumed to arrive at summer time, the season with the highest transmission (see 8)..
Figure 3
Figure 3
Logarithm of the risk of acquiring malaria for travellers to 5 regions, compared with the Brazilian Amazon region. The cost-benefit threshold is the thick horizontal line (see equation 1). Confidence intervals were omitted for the sake of clarity.
See this image and copyright information in PMC

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