Cost effectiveness analysis of chemoprophylaxis policy for travelers to malaria endemic areas

1. Cost effectiveness analysis of chemoprophylaxis policy for travelers to malaria endemic areas Enrique Morales Ingrid de Ruiter Ana Fried Tuesday, June 12th 2012 Health Economics

2. Background • Theimportation of malaria fromendemicto non-endemiccountriesis a major cause of travelrelatedmorbidity and hospitalisation. • Thisstudywill compare thecosteffectiveness of subsidising malaria prophylaxisforSwisstravellersto SSA with the current situation of not subsidising prophylaxis and the resulting burden of imported malaria cases of the Swiss healthsystem.

3. Modelled to estimate cost and effectiveness of 100% subsidy of malaria chemoprophylaxis regimen for travellers from Switzerland to Sub-Saharan Africa (SSA) compared to the current situation of no subsidy. Decision tree (+) signals the same tree as above in the figure.

4. Assumptions • All persons recieving subsidy take the chemoprophylactic treatment • 100% compliance to regimen • Type of chemoprophylaxis used for this study was limited to Malerone presribed for adults • Probability of contracting malaria without chemoprophylaxis is based on an average length of stay in SSA of 14 days • Viewpoint from health care system perspective

5. Costs • Subsidy of Malarone (100%) • 2 week course (minimum) = 51.841 € per pack x2 • Total = 103.68 € • Cost Per Case of Malaria 1Arzneimittel-Kompendium der Schweiz. [http://www.kompendium.ch/] 2Widmer et al. BMC Infectious Diseases 2010, 10:279 *ambulant malaria treatment includes two physician consultations, haematology and malaria parasite laboratory plus a treatment course of Riamet

6. Calulation of Probability (2) (1) (1) 0.002(100) + 0.6904 = 0.89 Therefore, 89% of people will access chemoprophylaxis when subsidised (1) Widmer et al. BMC Infectious Diseases 2010, 10:279T (2) Pistone et al. / Health Policy 88 (2008) 186–199

7. Probabilities *CurrentSituation

8. Swiss Malaria Cases per Year • 0.096% • 89% • 2.42% • 11% • 0.096% • 69% • 2.42% • 31%

9. Costs

10. Calculations • Annual number of Swiss travelers to SSA = 70,000 • The average age at death due to malaria in Switzerland is 51.3 years. • The life expectancy in Switzerland is around 83 years. 83-51.3=31.7 life years lost. • Assuming that the average quality of these 31.7 life years is 0.8 it would be 25 QALY. • € 1,583,254.67/25=63,330.00 € cost per QALY gained

11. Conclusions • NICE considers a treatment intervention with a threshold of 22,962.00 € - 34,443.00€ per QALY to be cost effective. • The 100% reimbursement of Malarone is not considered cost effective at 63,330.00 € per QALY according to the NICE guidelines.

12. Limitations • Doctor and prescription fees were not included • Use of other types of chemoprophylactic treatment (alternative price and side effect considerations) • Health care system view point meant out of pocket expenditure by travellers was not included in CE analysis • QALYs only takes into account prevented deaths and not prevented cases • Selection bias as unprepared travelers may not volunteer to provide data for the study • Potential overestimate of recourse in current situation in Switzerland (69%) and underestimate of current situation in France (84%)

13. References • 1. Pistone T, Schwarzinger M, Chauvin P, Ezzedine K, Receveur MC, Djossou F, et al. Reimbursement of malaria chemoprophylaxis for travellers from Europe to Sub-Saharan Africa: Cost-effectiveness analysis from the perspective of the French national health insurance system. Health policy. 2008;88(2):186-99. • 2. Widmer LL, Blank PR, Van Herck K, Hatz C, Schlagenhauf P. Cost-effectiveness analysis of malaria chemoprophylaxis for travellers to West-Africa. BMC infectious diseases. 2010;10(1):279. • 3. Christen D, Steffen R, Schlagenhauf P. Deaths caused by malaria in Switzerland 1988–2002. The American journal of tropical medicine and hygiene. 2006;75(6):1188-94.