Publication: Artemisinin resistance – modelling the potential human and economic costs
Issued Date
2014
Resource Type
Language
eng
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Mahidol University
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BioMed Central
Bibliographic Citation
Malaria Journal. Vol.13, (2014), 452
Suggested Citation
Yoel Lubell, Arjen Dondorp, Guérin, Philippe J, Tom Drake, Sylvia Meek, Elizabeth Ashley, Day, Nicholas PJ, White, Nicholas J, White, Lisa J Artemisinin resistance – modelling the potential human and economic costs. Malaria Journal. Vol.13, (2014), 452. Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/2903
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Title
Artemisinin resistance – modelling the potential human and economic costs
Abstract
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.