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Preventive malaria treatment for Ebola contacts cost-effective
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Public health officials should consider preventive malaria treatment for contacts of patients with Ebola virus disease in areas where malaria transmission is high, according to a study published in The Lancet Infectious Diseases.
“Malaria is endemic in West Africa, so accurate diagnosis of Ebola virus disease is difficult when the disease is in the early stages, since symptoms resemble those of febrile malaria,” Cristina Carias, PhD, of the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, and colleagues wrote. “As a result, 33% to 54% of patients admitted to [Ebola treatment units (ETUs)] during the 2014-2015 West Africa outbreak did not have Ebola virus disease. The provision of preventive malaria treatment to all contacts of patients with Ebola virus disease has thus been proposed as an option to prevent the onset of malaria fever and consequent inefficient allocation of ETU beds to patients with malaria, and exposure of these patients to Ebola virus.”
Carias and colleagues used a decision tree model to assess the economic feasibility of administering artemisinin-based combination treatment (ACT) to all contacts of patients with Ebola virus disease in West Africa.
The analysis lasted 1 year, roughly aligning with the West Africa Ebola outbreak. The researchers calculated the intervention’s cost per ETU admission averted by season (wet or dry), country (Liberia, Sierra Leone or Guinea) and age of contact (aged younger than 5 years, aged 5 to 14 years or aged 15 years and older). Sensitivity analyses were used to assess how results varied with malaria parasite prevalence in children aged 2 to 10 years, the daily cost of ETU stay, and the effectiveness of preventive malaria treatment and patients’ adherence to it.
From a health care perspective, administering ACTs to Ebola contacts resulted in cost savings for those of all ages in Liberia, Sierra Leone and Guinea, regardless of season, according to the researchers. In the wet season, preventive malaria treatment was estimated to reduce the chances of a contact being admitted to an ETU by 10% to 36%. Assuming 85% adherence to ACTs and taking into account the African population pyramid, the researchers expect ACTs to be cost saving in Ebola contacts across all age groups, even when malaria parasite prevalence in children aged 2 to 10 years is as low as 10%. During the wet season in Liberia, malaria preventive treatment was cost saving even as the average daily bed-stay costs were as low as $5 for children aged younger than 5 years, $9 for those aged 5 to 14 years, and $22 for those aged 15 years and older.
“This study provides a very strong justification for public health providers responding to an Ebola virus disease outbreak to consider distribution of preventive malaria treatment to contacts of patients with Ebola virus disease, in the context of an emergency response to Ebola virus disease outbreaks in malaria endemic areas,” Carias and colleagues wrote.
In a related editorial, Azra C. Ghani, PhD, and Patrick G. Walker, PhD, of the School of Public Health, Imperial College London, said extending ACT to areas with less intense seasonal transmission would not only be cost-effective as a malaria intervention, but it would reduce the burden on the health care system. This would, in turn, enable a more rapid response to future Ebola outbreaks.
“Any reduction in unnecessary admission to ETUs also has substantial benefits in terms of controlling the Ebola epidemic. Reducing the number of individuals in ETUs would not only be cost saving but also substantially relieve the pressure on an overburdened epidemic response,” Ghani and Walker wrote. “Additionally, it will reduce the potential for further transmission of Ebola virus disease within the ETUs.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures. Please see the full editorial for a list of the authors’ relevant financial disclosures.
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