Systematic review of microeconomic analysis of pregnancy-associated malaria

Abstract

Introduction Pregnancy-associated malaria (PAM) is a health problem with serious clinical, epidemiological and economic effects. Purpose To analyze the microeconomic evaluations of PAM reported in the world scientific literature. Methods Systematic review with 15 different search strategies in PubMed, ScienceDirect, Scielo, Google Scholar and Malaria in Pregnancy (MiP) Library. A search, selection and extraction protocol was applied, which guaranteed completeness and reproducibility in accordance with preferred reporting items for systematic reviews and meta-analysis guidelines. The methodological quality was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guide. The analysis were based on frequencies, costs and average and incremental cost-effectiveness ratios in 2018 US dollars adjusted for purchasing power parity. Results Twenty-two evaluations published between 1990 and 2018 were analyzed, of which 82% addressed cost-effectiveness in Africa. Twelve interventions were studied; of these, intermittent preventive treatment in pregnant women with sulfadoxine-pyrimethamine (IPTp-SP) was the most frequent strategy. The main outcomes were low birth weight, anaemia and DALYs avoided. The best average cost-effectiveness ratio was reported in IPTp-SP with a cost of US$ 2 per DALY avoided, followed by the administration of IPTp-SP in pregnant women with HIV (US$ 14.2). Conclusions The studies focus on Africa with a high heterogeneity in the interventions, outcomes, resources and populations studied. All the interventions were highly cost-effective, which demonstrates the importance of including prevention, care and control resources for PAM as a priority in health sector budgets. This is especially true considering the importance of its intervention for social progress and overcoming poverty in endemic areas.

Cost-effectiveness of rapid diagnostic tests, compared to microscopic tests, for the diagnosis and treatment of gestational malaria in Colombia from an institutional perspective

“…The consistency of the results evaluated during the sensitivity analysis, show that even with a cost-effectiveness < 5 times the per capita GDP, this is a high value for most scenarios, compared to thick blood smears. Although few studies evaluate malaria intervention in pregnant women, the results of this study are comparable to those from other countries [ 18 , 40 , 50 – 53 ], even including estimates from general populations sharing epidemiological and sociodemographic characteristics similar the ones in Colombia.…”

“…These strategies have proven to be highly cost-effective given that their costs are < 1 the per capita GDP in the countries analysed. This shows that in non-African countries, active screening and specific treatment using rapid tests provide comparable results to those of IPTp [ 18 ] in terms of effectiveness.…”

“…In response, several economic assessments have demonstrated the cost-effectiveness of PAM prevention [ 15 – 17 ]. In particular, a systematic review of economy studies on PAM, which implemented 9 search strategies in PubMed, Science Direct, Scielo, Google Scholar and Malaria in Pregnancy (MiP) Library, identified 22 studies [ 18 ] with the following results: most of the studies were mainly conducted in Africa and that did not include incremental or sensitivity analyses, reducing thus the internal and external validity of the conclusions; 90% were cost-effectiveness studies (in this type of economic study 82% evaluated IPTp) and the most common outcomes were LBW (65%), disability adjusted life years (DALYs) (55%), maternal anaemia (41%), and maternal malaria (29%).…”

Placental malaria caused by Plasmodium vivax or P. falciparum in Colombia: Histopathology and mediators in placental processes

“…All the interventions were highly cost-effective, which demonstrates the importance of including prevention, care, and control resources for PAM as a priority in health sector budgets. The IPTp with SP was the most frequent strategy [ 43 ].…”

Overview of Epidemiology of Malaria Associated with Pregnancy in Northwestern Colombia, 1985-2020

“…4 The information on MAP in Africa shows that the problem is serious according to its frequency, effects on maternal and child health, and economic consequences. [5][6][7] In Colombia MAP is also a serious clinical and public health problem, but with lower frequency. [8][9][10][11] The great area of the north of the country, from the Urabá Antioqueño region, to the west, the upper basins of the Sinú and San Jorge rivers, in the south of the department of Córdoba, and finally, to the east, the Bajo Cauca Antioqueño and the south of the department of Bolívar (hereinafter, the area is called "La Region") (Figure 1), generates more than 60% of the registered cases 12 and is the one that concentrates the scientific production on MAP in Colombia.…”