The cost-effectiveness of antenatal malaria prevention in sub-Saharan Africa

Antimalarial chemoprophylaxis during pregnancy significantly increases the birth weight of babies born to primigravidae, but coverage in sub-Saharan A frica is very limited. This analysis assessed whether increasing coverage i s justified on cost-effectiveness grounds. A standardized modeling framewor k was used to estimate ranges for the cost per discounted year of life lost averted by weekly chloroquine chemoprophylaxis and intermittent sulfadoxin e-pyrimethamine (SP) treatment for primigravidae in an operational setting with moderate to high malaria transmission. The SP regimen was found to be more cost-effective than the chloroquine regimen, because of both lower cos ts and higher compliance. Both regimens appear to be a good value for money in comparison with other methods of malaria control and based on rough cos t-effectiveness guidelines for low-income countries, even with high levels of drug resistance. However, extending the SP regimen to all gravidae and i ncreasing the number of doses per pregnancy could make the intervention sig nificantly less cost-effective.