Fig 1.
Design of the Incremental economic evaluation.
HIV = Human Immunodeficiency Virus; LLITNs = Long-Lasting Insecticide Treated Nets; CTX = Cotrimoxazole; IPTp = Intermittent Preventive Treatment of malaria in pregnancy; SP = Sulphadoxine-Pyrimethamine; MQ = Mefloquine. The figure shows that for both Trials the cost of LLITNs was not considered in the economic evaluation performed as women in both arms were administered with this preventative tool. The same applies for CTX in Trial on HIV-positive women. IPTp-placebo in Trial on HIV-positive women was considered as “doing nothing” option with no costs associated. Incremental net costs were calculated, which included the incremental costs of the intervention minus treatment savings due to its efficacy.
Table 1.
Input variables of the threshold and cost-effectiveness analyses of IPTp-MQ compared with IPTp-SP in HIV-negative pregnant women.
Table 2.
Input variables of the threshold and cost-effectiveness analyses of IPTp-MQ compared with IPTp-placebo in HIV-positive pregnant women.
Table 3.
HIV-negative trial: Results of cost-effectiveness analysis (per 1000 pregnant HIV-negative women).
Table 4.
HIV-positive trial: Results of the cost-effectiveness analysis (per 1000 pregnant HIV-positive women).
Fig 2.
Cost effectiveness plane: IPTp-MQ versus IPTp-SP in HIV-negative pregnant women in Benin, Gabon, Mozambique and Tanzania.
IPTp-MQ = Intermittent Preventive Treatment of malaria in pregnancy with Mefloquine; IPTp-SP = Intermittent Preventive Treatment of malaria in pregnancy with Sulphadoxine-Phyrimethamine; HIV = Human Immunodeficiency Virus; DALYs = Disability-adjusted life years. The graph plots 2,000 Monte Carlo simulations of the incremental cost-effectiveness ratio (ICER) with respect to its components: health impact (X-axis) and incremental costs (Y-axis). Average simulation point, ellipse of confidence (95%) and threshold level of the ICER (240 US$/DALY averted) are also depicted. Cost-effective dots are placed below/right the threshold line.
Fig 3.
Cost effectiveness plane: IPTp-MQ versus IPTp-SP in HIV-negative pregnant women in Benin, Mozambique and Tanzania.
IPTp-MQ = Intermittent Preventive Treatment of malaria in pregnancy with Mefloquine; IPTp-SP = Intermittent Preventive Treatment of malaria in pregnancy with Sulphadoxine-Phyrimethamine; HIV = Human Immunodeficiency Virus; DALYs = Disability-adjusted life years. The graph plots N = 2,000 Monte Carlo simulations of the incremental cost-effectiveness ratio (ICER) with respect to its components: health impact (X-axis) and incremental costs (Y-axis). Average simulation point, ellipse of confidence (95%) and threshold level of the ICER (240 US$/DALY averted) are also depicted. Cost-effective dots are placed below/right the threshold line.
Fig 4.
Cost effectiveness plane: IPTp-MQ versus IPTp-Placebo in HIV-positive pregnant women in Kenya, Mozambique and Tanzania.
IPTp-MQ = Intermittent Preventive Treatment of malaria in pregnancy with Mefloquine; HIV = Human Immunodeficiency Virus; DALYs = Disability-adjusted life years. The graph plots 2,000 Monte Carlo simulations of the incremental cost-effectiveness ratio (ICER) with respect to its components: health impact (X-axis) and incremental costs (Y-axis). Average simulation point, ellipse of confidence (95%) and threshold level of the ICER (240 US$/DALY averted) are also depicted.
Fig 5.
Cost-effectiveness of IPTp-MQ versus IPTp-SP in HIV-negative pregnant women in Benin, Gabon, Mozambique and Tanzania: acceptability curves.
IPTp-MQ = Intermittent Preventive Treatment of malaria in pregnancy with Mefloquine; IPTp-SP = Intermittent Preventive Treatment of malaria in pregnancy with Sulphadoxine-Phyrimethamine; HIV = Human Immunodeficiency Virus; DALYs = Disability-adjusted life years. Acceptability curves were constructed by plotting the cumulative distribution of the incremental cost-effectiveness ratios (ICERs) of IPTp-MQ compared with IPTp-SP per DALYs averted. The Y axis is interpreted as probability that the intervention is cost-effective for every level of policy makers’ willingness to pay for each DALY averted (X axis). US$ 136.30 per DALY averted (CI95% 131.41–141.18) is the ICER for the scenario including Benin, Gabon, Mozambique and Tanzania. US$ 237.99 (CI95% 230.99–244.57) per DALY averted is the ICER for the scenario excluding Gabon.
Fig 6.
Cost-effectiveness of IPTp-MQ versus IPTp-Placebo in HIV-positive pregnant women in Kenya, Mozambique and Tanzania: acceptability curve.
IPTp-MQ = Intermittent Preventive Treatment of malaria in pregnancy with Mefloquine; HIV = Human Immunodeficiency Virus; DALYs = Disability-adjusted life years. The acceptability curve was constructed by plotting the cumulative distribution of the incremental cost-effectiveness ratio (ICER) of IPTp-MQ compared with IPTp-Placebo per DALYs averted. The Y axis is interpreted as probability that the intervention is cost-effective for every level of policy makers’ willingness to pay for each DALY averted (X axis). US$ 6.96 per DALY averted (CI95% 4.22–9.70) is the ICER resulting from the analysis.
Fig 7.
Results of the threshold analysis of IPTp-MQ among HIV-negative and HIV-positive pregnant women.
IPTp = Intermittent Preventive Treatment of malaria in pregnancy; HIV = Human Immunodeficiency Virus; MQ = Mefloquine; SP = Sulphadoxine-Phyrimethamine; PYAR = Person-year at risk; RR = Relative Risk. The graph depicts up to which level (threshold level) several variables can increase or decrease from their current level for the interventions to remain cost-effective.