Оценка на разходната ефективност на употребата на химиопрофилактика при малария
Cost-Effectiveness Evaluation Of The Use Of Malaria Chemoprophylaxis

Summary/Abstract: The aim of the article is to evaluate the cost-effectiveness of malaria chemoprophylaxis in adult individuals using a cost-effectiveness economic analysis and applying the payer's perspective in Bulgaria (NHIF). The methodology includes documentary and comparative analysis of official recommendations and guidelines, as well as national legislation on chemoprophylaxis. Two economic models were used to assess the cost-effectiveness of chemoprophylaxis: the decision tree and the Markov model, created using the specialized modeling software TreeAge Pro 64-bit. A cost-effectiveness analysis was conducted to assess the cost-effectiveness of malaria chemoprophylaxis, using incremental values for costs and health benefits in the form of additional life years (LY). Based on these values, the incremental cost-effectiveness ratio (ICER=BGN/LY) was calculated. The analysis was performed at a cost-effectiveness threshold of BGN 86,215/LY (three times the GDP per capita for 2023 in Bulgaria, according to NSI data). The regimen chosen for modeling was Malarone (INN: atovaquone + proguanil hydrochloride). The decision tree traces the pathway of a patient exposed to malaria risk, with the final outcomes generated based on the probability of the modeled events occurring. The model assumes a 1-year duration, using annual probabilities of event occurrence, as well as annual values for health benefits and costs. The probability of mortality was calculated based on malaria mortality data in Bulgaria for the period 2011–2020 (2.70%), while the probability of recurrence was based on expert opinion (25%). The analysis shows that the "with prophylaxis" strategy is economically advantageous and effective. It results in an average cost of BGN 940.14 per patient, which is BGN 400.56 less compared to the "without prophylaxis" strategy. In addition to financial benefits, "with prophylaxis" provides an additional 1.08 years of life. According to the Markov model, the "with prophylaxis" strategy dominates by offering lower costs and higher health benefits.

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