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AT WHAT COST?Chloroquine-resistant malaria is becoming a major health care problem in much of Africa. Chloroquine though cheaper may not be effective and children treated with it may remain parasitaemic, febrile and at risk for complications and death. Alternative treatments are generally more expensive. Sudre et al (International Journal of Epidemiology 21:146-154, 1992) compared the cost-effectiveness of 3 different treatments, chloroquine (CQ), amodiaquine (AQ) and a pyrimethamine-sulfadoxine (PS) combination.

The authors used a decision-analysis model for their comparisons. The variables considered were the probability of P. falciparum infection, drug compliance, side-effects, level of drug resistance and case fatalities with each treatment. The measures of effectiveness were the number of malaria-related febrile episodes cured parasitologically with each treatment and the number of malaria deaths prevented in children 6-59 months old.

Data from their paper have been refashioned to produce the two figures (Fig 1 cure, Fig 2 prevention) given here.

Each figure relates costs to 3 levels of resistance.

I No resistance to ANY of the drugs

II Low resistance (low resistance to CQ, very little resistance to AQ and none to PS)

III High resistance (high resistance to CQ, moderate resistance to AQ and no resistance to PS)

Figure 1 |
Figure 2 |

Comments:

This problem served to introduce students to basic concepts in pharmacoeconomics. Like the earlier problem, Too Bloody Bad, this problem introduced students to basic concepts in pharmacoeconomics, particularly the different sorts of studies that could be conducted. The notion of perspective was discussed and students learned to look critically at such studies using published guidelines. In addition, students studied the life cycle of the malarial parasite and the drug treatment of the condition.

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