Background
Methods
Study design
Malaria chemoprophylaxis | Distribution of recourse to malaria chemoprophylaxis (based on records from the Swiss Tropical Institute, Basel) | Cost of malaria chemoprophylaxis for a two week stay in the current situation of no reimbursement | Cost of malaria chemoprophylaxis for a two week stay in the 80% reimbursement strategy |
---|---|---|---|
Mefloquine: Mephaquin® 8 tb box for € 22.21 | 55.4% | € 22.21 (maximal protection 21 days) | € 4.20 |
Atovaquone/proguanil: Malarone®
12 tb box for € 41.88 | 40.7% | € 83.75 (maximal 15 protection days) | € 65.99 |
Doxycycline: Supracyclin®
20 tb or 10 tb box for € 11.91 or € 6.40 | 3.9% | € 30.23 (maximal protection 20 days) | € 12.47 |
Input data
Definition of probabilities | Estimates (likliest, 95% CI) | Date of data | References |
---|---|---|---|
Current probability of recourse to malaria chemoprophylaxis in current situation of no reimbursement | 0.687/0.55/0.824 | 2002-2003 | |
Probability of recourse to malaria chemoprophylaxis in the 80% reimbursement strategy | 0.865/0.806/0.925 | - | |
Probability of recourse to mefloquine | 0.554 | 2007 | Personal evaluation at the STI1
|
Probability of recourse to atovaquone/proguanil | 0.407 | 2007 | Personal evaluation at the STI1
|
Probability of recourse to doxycycline | 0.039 | 2007 | Personal evaluation at the STI1
|
Probability of adverse events due to mefloquine leading to withdrawal | 0.04 (0.01-0.08) | 1998-2001 | [9] |
Probability of adverse events due to atovaquone/proguanil leading to withdrawal | 0.02 (0.00-0.04) | 1998-2001 | [9] |
Probability of adverse events due to doxycyline leading to withdrawal | 0.03 (0.00-0.06) | 1998-2001 | [9] |
Probability of severe adverse events due to mefloquine without withdrawal | 0.11 (0.06-0.15) | 1998-2001 | [9] |
Probability of severe adverse events due to atovaquone/proguanil without withdrawal | 0.07 (0.02-0.11) | 1998-2001 | [9] |
Probability of severe adverse events due to doxycyline without withdrawal | 0.06 (0.02-0.10) | 1998-2001 | [9] |
Probability of contracting malaria without malaria chemoprophylaxis | 0.0242 (Varied ± 30%: 0.017 - 0.0314) | - | [18] |
Prophylactic effectiveness of mefloquine | 0.945 (0.84-0.981) | 1993-1995 | [19] |
Prophylactic effectiveness of atovaquone/proguanil | 0.958 (0.915-0.975) | Metaanalysis 2007 | [20] |
Prophylactic effectiveness of doxycyline | 0.926 (0799-0.975) | 1995 | [21] |
Rate of hospitalisation of the imported malaria cases in Switzerland | 0.63 | 2003-2006 | Personal evaluation with data from FOPH2 and SFSO3
|
Medical cost variables
|
Estimates (likliest)
|
Date of data
|
References
|
Direct cost of mefloquine (Mephaquin®) for two weeks in 80% reimbursement strategy | € 17.77 | 2008 | [17] |
Cost to treat adverse events | € 37.59 | 2008 | Personal evaluation with TARMED4 and Swiss drug compendium[17] |
Direct cost of hospitalisation due to a malaria case | € 4763 | 2004-2005 | Personal communication (SFSO) |
Direct cost of ambulant treatment due to a malaria case | € 368 | 2008 | Personal communication (STI) |
Average indirect cost of sick leave due to a malaria case | € 2123 | 1996-2004 | Personal communication (SUVA5) |
Estimates on probabilities
Recourse to malaria chemoprophylaxis
Distribution of recourse to the different recommended malaria chemoprophylaxis regimens
The probability of contracting malaria in West Africa without malaria chemoprophylaxis
The probabilities of severe adverse events and withdrawals
Estimates on costs
The cost for the malaria chemoprophylactic regimens
The cost to treat severe adverse events
The cost to treat a malaria case
Analysis
Results
Cost and effect of the current situation and the 80% reimbursement strategy
Cost-effectiviness analysis with the three different estimated 'recourse to malaria chemoprophylaxis' | 55% | 68.70% | 82.40% | |||
---|---|---|---|---|---|---|
Current situation of no reimbursement | 80% reimbursement strategy | Current situation of no reimbursement | 80% reimbursement strategy | Current situation of no reimbursement | 80% reimbursement strategy | |
Cost per journey (€) (95% CI) | 65.45 (47.88 - 86.03) | 50.94 (41.25 - 62.36) | 50.05 (36.76 - 65.50) | 45.36 (37.38 - 54.96) | 36.64 (25.49 - 45.46) | 39.78 (33.42 - 47.74) |
Effect per journey (%) (95% CI) = probabilty of contracting malaria | 0.01196 (0.00861 - 0.01587) | 0.00625 (0.00445 -0.00836) | 0.00891 (0.00640 - 0.01184) | 0.00494 (0.00348 - 0.00669) | 0.00586 (0.00417 - 0.00786) | 0.00363 (0.00249 - 0.00506) |
Cost Effectiveness ratio (€) | ||||||
Per case of malaria prevented | - | 8'151 | - | 9'186 | - | 10'969 |
Per malaria related death prevented | - | 679'250 | - | 765'490 | - | 914'045 |
Incremental cost (€) of 80% reimbursement strategy | ||||||
Per additional malaria case prevented | Reference strategy | dominant | Reference strategy | dominant | Reference strategy | 2'302 |
Per additional malaria related death prevented | Reference strategy | dominant | Reference strategy | dominant | Reference strategy | 191'833 |
Cost-effectiviness analysis with the three different estimated 'recourse to malaria chemoprophylaxis' | 55% | 68.70% | 82.40% | |||
---|---|---|---|---|---|---|
Current situation of no reimbursement | 80% reimbursement strategy | Current situation of no reimbursement | 80% reimbursement strategy | Current situation of no reimbursement | 80% reimbursement strategy | |
Estimated number of travellers from Switzerland to West Africa | 70'000 | |||||
Cost per year (€) likliest | 4'581'654 | 3'565'716 | 3'503'346 | 3'175'326 | 2'425'038 | 2'784'936 |
Effect per year likliest | ||||||
Malaria cases | 837 | 438 | 624 | 346 | 410 | 254 |
Malaria-related deaths | 10 | 5 | 7 | 4 | 5 | 3 |
Effectiveness of 80% reimbursement strategy | ||||||
Malaria cases prevented | - | 399 | - | 278 | - | 156 |
Malaria-related deaths prevented | - | 5 | - | 3 | - | 2 |
Cost-effectiveness analysis of the 80% reimbursement strategy
The sensitivity analysis
Scenario | €/'malaria cases averted'* |
---|---|
Current probability of recourse to malaria chemoprophylaxis | |
Very low (40%) | dominant |
Low (55%) | dominant |
High (82.4%) | 2'302 |
Probability of contracting malaria without malaria chemoprophylaxis for a two week stay | |
Extremly low (= 0.4%) | 19'899 |
Very low (= 0.9%) | 5'922 |
Low, (= 1.2%) | 3'126 |
A bit low, -30% (= 1.7%) | 548 |
High, +30% (= 3.1%) | dominant |
Cost of the mefloquine drug | |
Low, -30% (= € 15.54) | dominant |
High, +30% (= € 28.86) | dominant |
Decrease of 'non-malaria chemoprophylaxis-users' due to the 80% reimbursement | |
Low, -30% (40%) | 126 |
High, +30% (74%) | dominant |
Reimbursement of the more expansive drugs | |
Doxycycline (€ 30.23) | dominant |
80% reimbursement of all three drugs | 4'968 |
Percentage of reimbursement of the cheapest malaria chemoprophylaxis | |
Very low (60%) | dominant |
Low (70%) | dominant |
High (90%) | dominant |
Very High (100%) | dominant |