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Economic case for a combined antimalarial-antibacterial rectal formulation for community use

Dates: 2008-2010
Funding Wellcome Trust
Collaborators Prof Nicholas J White FRS, Professor of Tropical Medicine at University Mahidol Thailand and University of Oxford
Information Borislava Mihaylova, James Buchanan, Alastair Gray

Severe malaria and bacterial infections are major causes of death in large parts of the developing world with overlapping symptoms. Clinical deterioration is often rapid (particularly in children), leading to inability to swallow medicines, preventing the use of oral therapies. Most deaths occur in rural villages where access to injectable treatments is usually hours or days travel away.

Researchers from the Wellcome Unit Faculty of Tropical Medicine, Mahidol University and the University of Oxford, the UNICEF/UNDP/World Bank/WHO Special Programme on Research and Training in Tropical Diseases and TropiVal Université Victor Segalen Bordeaux II are proposing to develop a combined rectal formulation of an antimalarial and an antibiotic as a pre-referral intervention for severe febrile illness in the community. Such a combined suppository could alleviate severe forms of febrile diseases and buy patients time to access appropriate care.

HERC researchers studied the economic case for this new intervention. This involved quantifying the burden of severe febrile illness to be targeted by the new intervention and evaluating the likely cost-effectiveness of the intervention under different scenarios of access to healthcare and implementation costs of the intervention. The work was published in Plos One. 46 million severe malaria and bacterial infections and 5 million deaths were estimated to occur worldwide each year, mostly in Sub-Saharan Africa (SSA) and South and South-east Asia (SEA). At annual delivery costs of $0.02/capita and 100% coverage, rectal antimalarials ($2 per dose) were projected to avert 240,000 deaths in SSA and 7,000 deaths in SEA at $5 and $177 per DALY avoided, respectively; rectal antibacterials ($2 per dose) were projected to avert 130,000 deaths in SSA and 27,000 deaths in SEA at $19 and $97 per DALY avoided, respectively. Combined rectal formulations ($2.50 per dose) were projected to avert 370,000 deaths in SSA and 33,000 deaths in SEA at $8 and $79 per DALY avoided, respectively, and are a cost-effective alternative to rectal antimalarials or antibacterials alone.The study found that antimalarial, antibacterial and combined rectal formulations were likely to be cost-effective interventions for severe febrile illness in the community.


Buchanan, J, Mihaylova, B, Gray, A, and White, N (2010). Cost-Effectiveness of Pre-Referral Antimalarial, Antibacterial, and Combined Rectal Formulations for Severe Febrile Illness PLoS ONE, 5(12):e14446.