Cost-effectiveness analysis of artesunate and quinine plus tetracycline for the treatment of uncomplicated falciparum malaria in Chanthaburi, Thailand

A randomized, controlled, malaria-clinic-based field trial was carried out to com pare the cost-effectiveness of a 5-day 700-mg oral artesunate and a 7-day quinine + tetracycline regimen for the treatment of uncomplicated fal ciparum malaria in Thailand. Cost-effectiveness was determined from the pro viders' perspective and based on curative effectiveness. A total of 137 pat ients, aged 15-60 years, attending a malaria clinic were followed for 28 da ys, 60 of them received quinine + tetracycline and 77 received artesunate. Cure rates were assessed on day 5 (artesunate) and day 7 (quinine + tetracy cline), using the intention-to-treat approach. Cost-effectiveness and sensi tivity analyses were performed by varying the day 5/day 7 curative effectiv eness and cost of artesunate. The cure rate with artesunate (100%) was sign ificantly higher than with quinine + tetracycline (77.4%) (relative risk ad justed for sex (aRR) = 1. 32, 95% confidence interval (CI) = 1.12-1.55; ref erent quinine + tetracycline). Artesunate was more cost-effective than quin ine + tetracycline at the following costs: artesunate, less than or equal t o US$ 0.36 per 50-mg tablet; quinine, US$ 0.06 per 300-mg tablet; tetracycl ine, US$ 0.02 per 250-mg capsule; and services per case found, less than or equal to US$ 11.49. Because of the higher cure rate and higher cost-effect iveness of the artesunate regimen compared with quinine + tetracycline, we recommend its use for the treatment of uncomplicated falciparum malaria in malaria clinics in Thailand.