Research

Cost of increasing access to artemisinin combination therapy: the Cambodian experience

Shunmay Yeung^1,2 , Wim Van Damme³ , Duong Socheat⁴ , Nicholas J White² and Anne Mills¹

¹Health Policy Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK

²Wellcome Trust – Mahidol University Oxford Tropical Medicine Research Programme, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajivithi Road, Bangkok 10400, Thailand

³Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, B-2000 Antwerpen, Belgium

⁴The National Centre for Parasitology, Entomology and Malaria Control, 372 Monivong Boulevard, Phnom Penh, Cambodia

author email corresponding author email

Malaria Journal 2008, 7:84doi:10.1186/1475-2875-7-84

Published:	20 May 2008

Abstract

Background

Malaria-endemic countries are switching antimalarial drug policy from cheap ineffective monotherapies to artemisinin combination therapies (ACTs) for the treatment of Plasmodium falciparum malaria and the global community are considering setting up a global subsidy to fund their purchase. However, in order to ensure that ACTs are correctly used and are accessible to the poor and remote communities who need them, specific interventions will be necessary and the additional costs need to be considered.

Methods

This paper presents an incremental cost analysis of some of these interventions in Cambodia, the first country to change national antimalarial drug policy to an ACT of artesunate and mefloquine. These costs include the cost of rapid diagnostic tests (RDTs), the cost of blister-packaging the drugs locally and the costs of increasing access to diagnosis and treatment to remote communities through malaria outreach teams (MOTs) and Village Malaria Workers (VMW).

Results

At optimum productive capacity, the cost of blister-packaging cost under $0.20 per package but in reality was significantly more than this because of the low rate of production. The annual fixed cost (exclusive of RDTs and drugs) per capita of the MOT and VMW schemes was $0.44 and $0.69 respectively. However because the VMW scheme achieved a higher rate of coverage than the MOT scheme, the cost per patient treated was substantially lower at $5.14 compared to $12.74 per falciparum malaria patient treated. The annual cost inclusive of the RDTs and drugs was $19.31 for the MOT scheme and $11.28 for the VMW scheme given similar RDT positivity rates of around 22% and good provider compliance to test results.

Conclusion

In addition to the cost of ACTs themselves, substantial additional investments are required in order to ensure that they reach the targeted population via appropriate delivery systems and to ensure that they are used appropriately. In addition, differences in local conditions, in particular the prevalence of malaria and the pre-existing infrastructure, need to be considered in choosing appropriate diagnostic and delivery strategies.