Artemisinin resistance-modelling the potential human and economic costs
© 2014 Lubell et al. Background: Artemisinin combination therapy is recommended as first-line treatment for falciparum malaria across the endemic world and is increasingly relied upon for treating vivax malaria where chloroquine is failing. Artemisinin resistance was first detected in western Cambod...
Saved in:
Main Authors: | , , , , , , , , |
---|---|
Other Authors: | |
Format: | Article |
Published: |
2018
|
Subjects: | |
Online Access: | https://repository.li.mahidol.ac.th/handle/123456789/34089 |
Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
Institution: | Mahidol University |
id |
th-mahidol.34089 |
---|---|
record_format |
dspace |
spelling |
th-mahidol.340892018-11-09T10:01:07Z Artemisinin resistance-modelling the potential human and economic costs Yoel Lubell Arjen Dondorp Philippe J. Guerin Tom Drake Sylvia Meek Elizabeth Ashley Nicholas P.J. Day Nicholas J. White Lisa J. White Mahidol University Nuffield Department of Clinical Medicine University of Oxford Malaria Consortium Immunology and Microbiology Medicine © 2014 Lubell et al. Background: Artemisinin combination therapy is recommended as first-line treatment for falciparum malaria across the endemic world and is increasingly relied upon for treating vivax malaria where chloroquine is failing. Artemisinin resistance was first detected in western Cambodia in 2007, and is now confirmed in the Greater Mekong region, raising the spectre of a malaria resurgence that could undo a decade of progress in control, and threaten the feasibility of elimination. The magnitude of this threat has not been quantified. Methods: This analysis compares the health and economic consequences of two future scenarios occurring once artemisinin-based treatments are available with high coverage. In the first scenario, artemisinin combination therapy (ACT) is largely effective in the management of uncomplicated malaria and severe malaria is treated with artesunate, while in the second scenario ACT are failing at a rate of 30%, and treatment of severe malaria reverts to quinine. The model is applied to all malaria-endemic countries using their specific estimates for malaria incidence, transmission intensity and GDP. The model describes the direct medical costs for repeated diagnosis and retreatment of clinical failures as well as admission costs for severe malaria. For productivity losses, the conservative friction costing method is used, which assumes a limited economic impact for individuals that are no longer economically active until they are replaced from the unemployment pool. Results: Using conservative assumptions and parameter estimates, the model projects an excess of 116,000 deaths annually in the scenario of widespread artemisinin resistance. The predicted medical costs for retreatment of clinical failures and for management of severe malaria exceed US$32 million per year. Productivity losses resulting from excess morbidity and mortality were estimated at US$385 million for each year during which failing ACT remained in use as first-line treatment. Conclusions: These 'ballpark' figures for the magnitude of the health and economic threat posed by artemisinin resistance add weight to the call for urgent action to detect the emergence of resistance as early as possible and contain its spread from known locations in the Mekong region to elsewhere in the endemic world. 2018-11-09T02:26:49Z 2018-11-09T02:26:49Z 2014-01-01 Article Malaria Journal. Vol.13, No.1 (2014) 10.1186/1475-2875-13-452 14752875 2-s2.0-84989243768 https://repository.li.mahidol.ac.th/handle/123456789/34089 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=84989243768&origin=inward |
institution |
Mahidol University |
building |
Mahidol University Library |
continent |
Asia |
country |
Thailand Thailand |
content_provider |
Mahidol University Library |
collection |
Mahidol University Institutional Repository |
topic |
Immunology and Microbiology Medicine |
spellingShingle |
Immunology and Microbiology Medicine Yoel Lubell Arjen Dondorp Philippe J. Guerin Tom Drake Sylvia Meek Elizabeth Ashley Nicholas P.J. Day Nicholas J. White Lisa J. White Artemisinin resistance-modelling the potential human and economic costs |
description |
© 2014 Lubell et al. Background: Artemisinin combination therapy is recommended as first-line treatment for falciparum malaria across the endemic world and is increasingly relied upon for treating vivax malaria where chloroquine is failing. Artemisinin resistance was first detected in western Cambodia in 2007, and is now confirmed in the Greater Mekong region, raising the spectre of a malaria resurgence that could undo a decade of progress in control, and threaten the feasibility of elimination. The magnitude of this threat has not been quantified. Methods: This analysis compares the health and economic consequences of two future scenarios occurring once artemisinin-based treatments are available with high coverage. In the first scenario, artemisinin combination therapy (ACT) is largely effective in the management of uncomplicated malaria and severe malaria is treated with artesunate, while in the second scenario ACT are failing at a rate of 30%, and treatment of severe malaria reverts to quinine. The model is applied to all malaria-endemic countries using their specific estimates for malaria incidence, transmission intensity and GDP. The model describes the direct medical costs for repeated diagnosis and retreatment of clinical failures as well as admission costs for severe malaria. For productivity losses, the conservative friction costing method is used, which assumes a limited economic impact for individuals that are no longer economically active until they are replaced from the unemployment pool. Results: Using conservative assumptions and parameter estimates, the model projects an excess of 116,000 deaths annually in the scenario of widespread artemisinin resistance. The predicted medical costs for retreatment of clinical failures and for management of severe malaria exceed US$32 million per year. Productivity losses resulting from excess morbidity and mortality were estimated at US$385 million for each year during which failing ACT remained in use as first-line treatment. Conclusions: These 'ballpark' figures for the magnitude of the health and economic threat posed by artemisinin resistance add weight to the call for urgent action to detect the emergence of resistance as early as possible and contain its spread from known locations in the Mekong region to elsewhere in the endemic world. |
author2 |
Mahidol University |
author_facet |
Mahidol University Yoel Lubell Arjen Dondorp Philippe J. Guerin Tom Drake Sylvia Meek Elizabeth Ashley Nicholas P.J. Day Nicholas J. White Lisa J. White |
format |
Article |
author |
Yoel Lubell Arjen Dondorp Philippe J. Guerin Tom Drake Sylvia Meek Elizabeth Ashley Nicholas P.J. Day Nicholas J. White Lisa J. White |
author_sort |
Yoel Lubell |
title |
Artemisinin resistance-modelling the potential human and economic costs |
title_short |
Artemisinin resistance-modelling the potential human and economic costs |
title_full |
Artemisinin resistance-modelling the potential human and economic costs |
title_fullStr |
Artemisinin resistance-modelling the potential human and economic costs |
title_full_unstemmed |
Artemisinin resistance-modelling the potential human and economic costs |
title_sort |
artemisinin resistance-modelling the potential human and economic costs |
publishDate |
2018 |
url |
https://repository.li.mahidol.ac.th/handle/123456789/34089 |
_version_ |
1763496709888933888 |