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Financial Implications of Refugee Malaria: The Impact of Pre-Departure Presumptive Treatment with Anti-Malarial Drugs

This study is a cost-benefits analysis of the recommendations of the Centers for Disease Control and Prevention for presumptive anti-malarial treatment among departing West African refugees. We conducted a retrospective chart review of symptomatic, blood smear–positive cases of malaria seen in Minneapolis, Minnesota, from 1996 through 2005. Billing charges of U.S. care were compared with estimates of implementation costs for overseas treatment. Fifty-eight symptomatic malaria infections occurred among West African refugees. After overseas pre-departure presumptive treatment, symptomatic malaria in arriving refugees decreased from 8.2% to 0%. The pre-departure number needed to treat to prevent one case of symptomatic malaria is 13.9 (95% confidence interval = 9.8–24). The average U.S. billing charge for each malaria case is $1,730. Overseas implementation costs for presumptive treatment are estimated to be between $141 and $346 to prevent one U.S. malaria case. Overseas presumptive pre-departure anti-malarial therapy prevents clinical malaria in refugees and results in cost-benefits when the malaria prevalence is > 1%. Overseas presumptive therapy has greater cost-benefits than U.S. based screening and treatment strategies.

Received February 13, 2007. Accepted for publication June 6, 2007.

Acknowledgments: We thank the HCMC microbiology laboratory and Blain Mamo (Minnesota Department of Health) for their assistance; and Julie Boulware for graphic design.

Financial support: William M. Stauffner and David R. Boulware received support from National Institute of Allergy and Infectious Diseases/National Institutes of Health grant T32-AI055433.

^* Address correspondence to David R. Boulware, Division of Infectious Disease and International Medicine, Departments of Medicine and Pediatrics, University of Minnesota, 420 Delaware Street SE, Mayo Building D407, MMC 250, Minneapolis, MN 55455. E-mail: boulw001{at}umn.edu

Authors’ addresses: Stefan Collinet-Adler, Kevin L. Larsen, and David N. Williams, Department of Medicine, Hennepin County Medical Center, 701 Park Avenue South, Minneapolis, MN 55415. William M. Stauffer, David R. Boulware, and Tyson B. Rogers, Division of Infectious Disease and International Medicine, Departments of Medicine and Pediatrics, University of Minnesota, 420 Delaware Street SE, Mayo Building D407, MMC 250, Minneapolis, MN 55455.

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