Artesunate suppository as a pre-referral intervention for severe malaria

Severe malaria is a serious condition with substantial risk of death largely dependent on the time between the onset of symptoms and treatment. Rapid access to effective treatment is essential, but for many patients oral drugs cannot be taken because of their symptoms (e.g. vomiting, convulsions, coma), and hospitals providing alternative non-oral treatment are often inaccessible. The artesunate suppository can be made available in remote areas and can be given at the onset of symptoms. A major placebo-controlled clinical trial published in 2009 found that this intervention at the time of referral substantially reduces the risk of death or permanent disability (Gomes et al. 2009, "Pre-referral rectal artesunate to prevent death and disability in severe malaria: a placebo-controlled trial", Lancet, vol. 373, no. 9663, pp. 557-566.).

Following the completion of this study and as a further deployment study of artesunate suppository was nearing completion HERC started work on the health economics of this intervention in collaboration with researchers from the WHO. The work uses data from the placebo-controlled trial as well as data from the deployment study to evaluate the cost-effectiveness of artesunate suppository in rural communities in Africa.

A preliminary analysis “Cost-effectiveness of pre-referral rectal artesunate for suspected severe malaria” was presented at the 58th meeting of the American Society of Tropical Medicine and Hygiene, in Washington in November 2009.