Economics of malaria prevention in US travelers to West Africa

Abstract

Background: Pretravel health consultations help international travelers manage travel-related illness risks through education, vaccination, and medication. This study evaluated costs and benefits of that portion of the health consultation associated with malaria prevention provided to US travelers bound for West Africa.

Methods: The estimated change in disease risk and associated costs and benefits resulting from traveler adherence to malaria chemoprophylaxis were calculated from 2 perspectives: the healthcare payer's and the traveler's. We used data from the Global TravEpiNet network of US travel clinics that collect de-identified pretravel data for international travelers. Disease risk and chemoprophylaxis effectiveness were estimated from published medical reports. Direct medical costs were obtained from the Nationwide Inpatient Sample and published literature.

Results: We analyzed 1029 records from January 2009 to January 2011. Assuming full adherence to chemoprophylaxis regimens, consultations saved healthcare payers a per-traveler average of $14 (9-day trip) to $372 (30-day trip). For travelers, consultations resulted in a range of net cost of $20 (9-day trip) to a net savings of $32 (30-day trip). Differences were mostly driven by risk of malaria in the destination country.

Conclusions: Our model suggests that healthcare payers save money for short- and longer-term trips, and that travelers save money for longer trips when travelers adhere to malaria recommendations and prophylactic regimens in West Africa. This is a potential incentive to healthcare payers to offer consistent pretravel preventive care to travelers. This financial benefit complements the medical benefit of reducing the risk of malaria.

Keywords: benefits; costs; malaria prevention; pretravel health consultation.

Figure 1.

Examples of destination-specific diseases and health risks to a traveler to West Africa assessed via a pretravel health consultation. The pretravel health consultation will also provide an opportunity to confirm that routine vaccinations for diseases denoted in the shaded ovals are up-to-date or to administer these vaccines. Abbreviations: HIV, human immunodeficiency virus; STIs, sexually transmitted infections.

Figure 2.

Net costs/savings for pretravel health consultations against malaria with 100% adherence to recommended malaria chemoprophylaxis regimens: healthcare payer's perspective (A); traveler's perspective (B). The estimations were carried out by simultaneously varying the risk of contracting malaria, input parameters, and various cost categories by using upper, baseline, and lower bounds of ranges (Tables 1–3). A negative value on the vertical axis indicates that pretravel health consultations against malaria will result in a net cost to a healthcare payer or traveler, whereas a positive value indicates a net savings to a healthcare payer or traveler. West Africa included Benin, Burkina Faso, Cape Verde, Côte d'Ivoire, The Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, São Tomé and Príncipe, Senegal, Sierra Leone, and Togo [1]. The arrow line (↔) on the horizontal axis indicates the range of risk of contracting malaria adjusted for the length of travel using the estimated incidence rate (0.4 per 1000 person-days to 2.3 per 1000 person-days) [10]. The daily risk was assumed to be spread evenly over the median length of travel; eg, for a leisure traveler, the range of malaria risk during a 14-day trip was from 5.6 per 1000 (0.4 per 1000 × 14 days) to 32.2 per 1000 (2.3 per 1000 × 14 days).

Figure 3.

Multiway sensitivity analyses: 60% adherence to recommended malaria chemoprophylaxis regimens—net costs/savings for pretravel health consultation against malaria: healthcare payer's perspective (A); traveler's perspective (B). Multiway sensitivity analyses were conducted by simultaneously varying the risk of contracting malaria, input parameters, and various cost categories by using upper, baseline, and lower bounds of ranges (Tables 1–3). A negative value on the vertical axis indicates that pretravel medical consultation against malaria will result in a net cost to a healthcare payer or a traveler, whereas a positive value indicates a net savings to healthcare payer or a traveler. West Africa included Benin, Burkina Faso, Cape Verde, Côte d'Ivoire, The Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, São Tomé and Príncipe, Senegal, Sierra Leone, and Togo [1]. The arrow line (↔) on the horizontal axis indicates the range of risk of contracting malaria adjusted for the length of travel using the estimated incidence rate (0.4 per 1000 person-days to 2.3 per 1000 person-days) [10]. The daily risk was assumed to be spread evenly over the median length of travel; eg, for a leisure traveler, the range of malaria risk during a 14-day trip was from 5.6 per 1000 (0.4 per 1000 × 14 days) to 32.2 per 1000 (2.3 per 1000 × 14 days).