Assessing the cost-effectiveness of prereferral rectal artesunate for treatment of severe childhood malaria.

Tozan and colleagues present the first detailed cost-effectiveness study of community-based prereferral artesunate treatment of children suspected of having severe malaria in areas with poor access to formal healthcare. Modeling a cohort of 1000 newborn babies up to 5 years of age, the cost-effectiveness (in 2008 international dollars [I$]) of the intervention is reported from the provider perspective. Cost-effectiveness results are presented for scenarios with low (25%), moderate (50%), high (75%) and full (100%) intervention uptake and referral compliance. At low intervention uptake and referral compliance, the intervention is estimated to avert 19 disability-adjusted life-years (DALYs; 95% CI: 16-21) and to cost I$1173 (95% CI: 1050-1297) per DALY averted. Under the full uptake and compliance scenario, the intervention averts 967 DALYs (95% CI: 884-1050) at a cost of I$77 (95% CI: 73-81) per DALY averted. Tozan and colleagues' findings suggest that prereferral artesunate treatment is a cost-effective, life-saving intervention in rural African settings where functioning community health workers exist.