Figure 1.
Illustration of the Markov model.
Patients transition through the 13 states, each of which has its associated costs and health outcomes. The arrows depict which transitions can occur from one cycle to the next. The transition probabilities differ between patients that receive HMM and those who do not, and according to whether patients can access appropriate health care facilities.
Table 1.
Parameter values.
Figure 2.
The lower panel is the model output indicating the circumstances in which HMM is likely to be appropriate. Above this are the controls where the user can adjust the costs and transition probabilities, select drugs for both HMM and health facilities, determine the perspective for the analysis, and set the decision threshold.
Table 2.
Costing results.
Figure 3.
Model output for the Uganda HMM programme using CQ+SP from a provider perspective.
The model suggests that HMM will only be efficient in areas of medium and high transmission, where the probability of appropriate care is low. In low transmission areas HMM is more effective but too costly, and is not cost-effective. CQ+SP = chloroquine + sulfadoxine-pyrimethamine.
Figure 4.
Model output for the Uganda HMM programme using AL from a provider perspective.
Introducing AL into HMM appears to be efficient in most medium to high transmission areas, unless the probability that a child will receive appropriate care from a health facility is 100%. AL = artemether-lumefantrine.
Figure 5.
Model output for the Uganda HMM programme using a hypothetical ‘ideal’ antimalarial from a provider perspective.
These results indicate that even if an ‘ideal’ antimalarial is introduced into HMM, the settings where HMM is cost-effective remain limited to medium and high transmission areas, unless the probability of receiving appropriate care is zero.
Figure 6.
Model output for the Uganda HMM programme using AL from a societal perspective.
Under this scenario HMM is only warranted in medium to high transmission areas and where the probability of appropriate care is low.
Figure 7.
Model output for the Uganda HMM programme using AL in the context of a lower burden of non-malaria febrile illnesses.
When the proportion of non-malaria febrile illnesses are assumed to require less antibiotics and their health outcomes is estimates as less severe HMM appears more beneficial in almost all areas.