Cost effectiveness of intermittent screening followed by treatment versus intermittent preventive treatment during pregnancy in West Africa: analysis and modelling of results from a non-inferiority trial

Fernandes, Silke; Sicuri, Elisa; Halimatou, Diawara; Akazili, James; Boiang, Kalifa; Chandramohan, Daniel; Coulibaly, Sheikh; Diawara, Sory Ibrahim; Kayentao, Kassoum; ter Kuile, Feiko; Magnussen, Pascal; Tagbor, Harry; Williams, John; Woukeu, Arouna; Cairns, Matthew; Greenwood, Brian; Hanson, Kara

doi:10.1186/s12936-016-1539-4

Table 1 Input variables for the cost consequence analysis and the base case and probabilistic cost-effectiveness analysis

From: Cost effectiveness of intermittent screening followed by treatment versus intermittent preventive treatment during pregnancy in West Africa: analysis and modelling of results from a non-inferiority trial

Parameter	Base case	Low	High	Distribution for PSA	Source
Cost estimates
Health care worker time cost
Time nurses take to provide 1 dose IPTp-SP in Ghana (min) 95 % CI (N = 18)	18.00	15.54	20.46	Gamma	Observational study of trial participants: (Ghana)
Time nurses take to provide 1 dose IPTp-SP in Malawi (min) 95 % CI (N = 18)	3.55	2.58	4.52	Gamma	Observational study of trial participants: (Malawi)
Time nurses take to provide 1 admin ISTp-AL in Ghana (min) 95 % CI (N = 3) if RDT neg	13.67	9.87	17.46	Gamma	Observational study of trial participants: (Ghana)
Time nurses take to provide 1 admin ISTp-AL in Ghana (min) 95 % CI (N = 13) if RDT pos	24.29	21.43	27.16	Gamma	Observational study of trial participants: (Ghana)
Time nurses take to provide 1 admin ISTp-AL in Malawi (min) 95 % CI (N = 22) if RDT neg	5.67	4.91	6.44	Gamma	Observational study of trial participants: (Malawi)
Time nurses take to provide 1 admin ISTp-AL in Malawi (min) 95 % CI (N = 8) if RDT pos	12.65	11.52	13.78	Gamma	Observational study of trial participants: (Malawi)
Number of administrations in IPTp-SP arm	2.06	–	–	Point estimate	[20]
Number of administrations in ISTp-AL arm	2.76	–	–	Point estimate	[20]
% of administrations of ISTp with a positive RDT result	24.7 %			Point estimate	[20]
Nurses’ monthly cost of labour, 95 % CI (US$ 2012)	346.33	164.83	527.84	Gamma	Countries MoH^a
Drug costs
Average SP price per administration, 95 % CI (US$ 2012)	0.20	0.16	0.27	Lognormal	International procurement databases^b
Average AL price per administration, 95 % CI (US$ 2012)	2.39	1.71	3.06	Lognormal	International procurement databases^b
Average RDT price per administration, 95 % CI (US$ 2012)	0.81	0.58	0.90	Lognormal	International procurement databases^b
Costs from consequences
Incremental days in hospital comparing LBW versus NBW (days)	0.64	0.40	0.89	Normal	Trial post partum follow up data
Cost per paediatric IP day (excluding medical supplies) (US$ 2012)	63.46	31.73	95.19	Gamma	Health facility costings (Ghana, Mali)
Cost per OP visit (excluding medical supplies) (US$ 2012)	11.76	8.45	15.06	Gamma	Health facility costings (Ghana, Mali)
Cost per IP day (excluding medical supplies) (US$ 2012)	35.25	17.63	52.88	Gamma	Health facility costings (Ghana, Mali)
Daly calculations
Discount rate r	0.03	0.00	0.05	Point estimate	Assumption
Average age (years)^c	20.40	–	–	Point estimate	[20]
Life expectancy women aged 20–24 years	50.12	45.11	55.13	Lognormal	GBD study 2010^d [32]
Life expectancy at birth	61.56	56.86	66.31	Lognormal	GBD study 2010^d [32]
Length disability—malaria during pregnancy (3.5 days, range 2–6)	0.010	0.005	0.016	Gamma	Assumption
Length disability—malaria related anaemia (21 days, range 14–42)	0.06	0.04	0.12	Gamma	Price et al. [33]
Length disability—LBW (years)	57.96	52.91	64.80	Lognormal	GBD 2010 study [32]
Disability weight infectious disease severe acute episode (95 % CI)	0.21	0.14	0.30	Lognormal	GBD 2010 study [25]
Disability weight maternal anaemia: moderate (95 % CI)	0.06	0.04	0.09	Lognormal	GBD 2010 study [25]
Disability weight LBW	0.11	–	–	Point estimate	GBD 2004 update (data from 1990) [26]
Mortality estimates
LBW attributable neonatal mortality risk %	6.93	4.36	9.50	Beta	Marchant et al. [34]
CFR malaria during pregnancy %	0.0033	0.0026	0.0045	Beta	Sicuri et al. [35]
CFR moderate/severe anaemia in pregnancy %	0.01	–	–	Beta	Brabin et al. [36]
Measures of effect (trial conducted in Primi- and secundigravidae only)
Low birth weight
LBW risk IPTp-SP arm per 1000 women	151.2	136.8	166.8	Beta	[20]
LBW risk ISTp-AL arm per 1000 women	155.8	141.3	171.5	Beta	[20]
Moderate/severe maternal anaemia (<8, 7, or 6 g/dl)
Moderate/severe anaemia risk at last ANC visit IPTp-SP arm per 1000 women	16.9	11.6	24.7	Beta	[20]
Moderate/severe anaemia risk at last ANC visit ISTp-AL arm per 1000 women	23.1	16.8	31.7	Beta	[20]
Episodes of clinical malaria
0 episode clinical malaria IPTp-SP arm per 1000 women	932.41	922.26	941.33	Dirichlet	[20]
1 episode clinical malaria IPTp-SP arm per 1000 women	61.99	53.45	71.78	Dirichlet	[20]
2 episodes clinical malaria IPTp-SP arm per 1000 women	5.6	3.38	9.27	Dirichlet	[20]
3 episodes clinical malaria IPTp-SP arm per 1000 women	0.4	0.36	0.44	Dirichlet	[20]
0 episode clinical malaria ISTp-AL arm per 1000 women	899.85	887.88	910.67	Dirichlet	[20]
1 episode clinical malaria ISTp-AL arm per 1000 women	84.08	74.14	95.21	Dirichlet	[20]
2 episodes clinical malaria ISTp-AL arm per 1000 women	14.95	10.98	20.32	Dirichlet	[20]
3 episodes clinical malaria ISTp-AL arm per 1000 women	0.37	0.05	2.65	Dirichlet	[20]
Measures of effect from cochrane review used for modelling of decreasing SP efficacy in IPTp arm
Relative risk of LBW comparing IPTp-SP versus none or placebo	0.81	0.67	0.99	n/a	[30]
Relative risk of sev/mod anaemia comparing IPTp-SP versus none or placebo	0.60	0.47	0.75	n/a	[30]
Relative risk of antenatal parasitaemia comparing IPTp-SP versus none or placebo	0.38	0.24	0.59	n/a	[30]

Parameters are shown for all countries where the clinical trial was conducted in [32] (Burkina Faso, Ghana, Mali and The Gambia)
ANC antenatal care; CFR case fatality rate; DALY disability adjusted life years; HCW health care worker; IPTp-SP intermittent preventive treatment with sulfadoxine-pyrimethamine; ISTp-AL intermittent screening and if positive followed by treatment with arthemether-lumefantrine; LBW low birth weight; MoH Ministry of Health; 95 % CI 95 % confidence interval
^aSalary scale and an average allowance package for nurses from Ministry of Health in Burkina Faso, Ghana, Mali and The Gambia for 2012
^bCost for dose of SP, AL and per RDT was calculated accounting for 5 % wastage, 10 % insurance and freight and 10 % in country transport
^cAverage age was used from the trial
^dThe life expectancy was analysed from the Global burden of disease 2010 database for the subgroups of interest (i.e. female only, age 20–24, trial countries and both gender, at birth, trial countries respectively)

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