PharmacoEconomics & Outcomes News 578 - 16 May 2009

reduction in hospital admissions, were modest".Malaria home management - urbanIn an accompanying editorial, Karin Kallander andUgandan children overtreated Jesca Nsungwa-Sabiiti, from the Karolinska Insitute,

Sweden say that, while home management withAlthough home management of malaria withartemether/lumefantrine may not be the answer inartemether/lumefantrine leads to prompt treatment ofurban areas, integrating strategies like rapid diagnosticfever in urban Ugandan children, the strategy has littletests and adapted communication strategies witheffect on clinical outcomes at a cost of substantialenvironmental management and promotion of bed nets,overtreatment, according to a study published in Thecould contain urban malaria.2 "Thus strategies for theLancet.control of malaria that favour people who are poor areThe trial included children aged between 1 andalso essential for urban areas, especially for slums."6 years living in Kampala, Uganda - a low-transmission

urban setting - whose households were randomised to * according to weight-based guidelines for empiric treatmentreceive home management of malaria or standard care 1. Staedke SG, et al. Home management of malaria with artemether-lumefantrinefor 12 months.1 Home management households compared with standard care in urban Ugandan children: a randomised

controlled trial. Lancet 373: 1623-1631, No. 9675, 9 May 2009.received prepackaged artemether/lumefantrine2. Kallander K, et al. Home-based management of malaria in the era of20mg/120mg, to be given twice daily for 3 days* if the urbanisation. Lancet 373: 1582-1584, No. 9675, 9 May 2009.

801108376child developed fever. Home management wascompared to standard care and to a concurrent clinicalcohort in the same area to determine treatmentincidence density (antimalarial treatments per person-year).

The analysis for the primary endpoint included217 children in the home management group and208 children in the standard care group. Childrenassigned to home management received nearly twice asmany antimalarial treatments as children in the controlgroup (4.66 per person-year vs 2.53 per person-year;multivariable adjusted incidence rate ratio [IRR] 1.7295% CI 1.43, 2.06; p < 0.0001) [see table] and almostfive times the number given to children withmicroscopically confirmed malaria in the comparablecohort of children (4.66 per person-year vs 1.03 perperson-year; IRR 5.19, 4.24, 6.35; p < 0.0001).

Incidence: antimalarial treatments and illnessepisodes

Events Incidencea Multivariateanalysis

IRR 95% CI

Antimalarial treatmentsStandard care 437 2.53 1.00Home managementb 866 4.66 1.72 1.43, 2.06d

Clinic-based cohortc 366 1.03 0.35 0.27, 0.45d

Illness episodesStandard care 1184 6.84 1.00Home managementb 1381 7.42 1.06 0.94, 1.19Clinic-based cohortc 3435 9.70 1.39 1.25, 1.55d

Fever episodesStandard care 570 3.29 1.00Home managementb 862 4.63 1.31 1.12, 1.53Clinic-based cohortc 1179 3.33 0.99 0.85, 1.15Hospital admissionsStandard care 40 0.23 1.00Home managementb 25 0.13 0.57 0.31, 1.06Clinic-based cohortc 27 0.08 0.34 0.19, 0.59d

a per person-yearb IRRs for home management vs standard carec IRRs for clinic-based cohort vs standard cared p < 0.0001

The researchers say that, despite the proportion ofantimalarial treatments deemed prompt and effectivebeing more than seven times higher in the interventiongroup than in the control group, the "health benefitsassociated with the home management intervention,including a lower frequency of parasitemia and a

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PharmacoEconomics & Outcomes News 16 May 2009 No. 5781173-5503/10/0578-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved