Cost-effectiveness of sulfadoxine-pyrimethamine for the prevention of malaria-associated low birth weight

Prevention of placental malaria through administration of antimalarial medi cations to pregnant women in disease-endemic areas decreases the risk of de livery of low birth weight (LBW) infants. In areas of high Plasmodium falci parum transmission, two intermittent presumptive treatment doses of sulfado xine-pyrimethamine (SP) during the second and third trimesters of pregnancy are effective in decreasing the prevalence of placental malaria in human i mmunodeficiency virus (HIV)-negative women, while HIV-positive women may re quire a monthly SP regimen to reduce their prevalence of placental parasite mia. A decision-analysis model was used to compare the cost-effectiveness o f three different presumptive SP treatment regimens with febrile case manag ement with SP in terms of incremental cost per case LBW prevented. Factors considered included HIV seroprevalence, placental malaria prevalence, LBW i ncidence, the cost of SP, medical care for LBW infants, and HIV testing. Fo r a hypothetical cohort of 10,000 pregnant women, the monthly SP regimen wo uld always be the must effective strategy for reducing LBW associated with malaria. The two-dose SP and monthly SP regimens would prevent 172 and 229 cases of LBW, respectively, compared with the case management approach. At HIV seroprevalence rates greater than 10%, the monthly SP regimen is the le ast expensive strategy. At HIV seroprevalence rates less than 10%, the two- dose SP regimen would be the less expensive option. When only antenatal cli nic costs are considered, the two-dose and monthly SP strategies cost US$11 and $14, respectively, well within the range considered cost effective. Pr esumptive treatment regimens to prevent LBW associated with malaria and the subsequent increased risk: of mortality during the first year of life are effective and cost effective strategies in areas with both elevated HIV pre valence and malaria transmission rates.