Table 1.
Data inputs for the adapted Substandard and Falsified Antimalarial Research Impact (SAFARI) model
| Model inputs | Estimate | SD (range) | Source |
|---|---|---|---|
| Demographic and epidemiological data | |||
| Benin population < 5 y old | 1,909,000 | – | – |
| Malaria cases of children < 5 y old | 1,774,127 | – | WHO,9 Centers for Disease Control and Prevention22 |
| Case fatality rate for severe malaria in the community | 0.150 | 0.03* | Camponovo et al.33 |
| Case fatality rate, inpatient care | 0.097 | 0.02* | Camponovo et al.33 |
| Neurological sequelae rate (care sought) | 0.031 | (0.028–0.035) | Dondorp et al.36 |
| Neurological sequelae rate (care not sought) | 0.194 | 0.028 | Dondorp et al.36 |
| Probability of testing | Institut National de la Statistique et de l’Analyse Économique, ICF19 | ||
| Public facilities | 0.519 | – | |
| Private facilities | 0.296 | – | |
| Pharmacies | 0.085 | – | |
| Drug stores | 0.073 | – | |
| Cure rates | Abdulla et al.,17 Faucher et al.18 | ||
| ACT | 0.973 | 0.020 | |
| CQ | 0.444 | 0.112 | |
| Quinine | 0.710 | 0.087 | |
| Other treatment | 0.819 | 0.100 | |
| No treatment | 0.000 | – | |
| Caregiver length of care, d | 5 | – | Assumption |
| Length of illness, d | 5 | – | Assumption |
| Medication taken by facility | |||
| Public facilities | Institut National de la Statistique et de l’Analyse Économique, ICF19 | ||
| ACT | 52.3% | – | |
| CQ | 15.8% | – | |
| Quinine | 20.4% | – | |
| Other treatment | 11.6% | – | |
| Private facilities | |||
| ACT | 36.0% | – | |
| CQ | 2.9% | – | |
| Quinine | 30.9% | – | |
| Other treatment | 30.3% | – | |
| Pharmacies | |||
| ACT | 26.3% | – | |
| CQ | 36.9% | – | |
| Quinine | 24.0% | – | |
| Other treatment | 12.8% | – | |
| Drug stores | |||
| ACT | 29.8% | – | |
| CQ | 24.0% | – | |
| Quinine | 35.2% | – | |
| Other treatment | 11.0% | – | |
| Self-treatment | |||
| ACT | 33.8% | – | |
| CQ | 33.2% | – | |
| Quinine | 18.6% | – | |
| Other treatment | 14.2% | – | |
| Care-seeking behavior | |||
| Public facilities | 20.7% | – | Institut National de la Statistique et de l’Analyse Économique, ICF 19 |
| Private facilities | 8.4% | – | |
| Pharmacies | 9.2% | – | |
| Drug stores | 11.1% | – | |
| Self-treatment | 22.8% | – | |
| No treatment | 27.8% | – | |
| SF and treatment adherence proportions | |||
| ACT SF proportions | Baba-Moussa et al.24 | ||
| Not SF: API > 85% | 67.5% | – | |
| Category 1: API = 75–85% | 26.9% | – | |
| Category 2: API = 50–75% | 26.9% | – | |
| Category 3: API < 50% | 46.2% | – | |
| Treatment adherence proportions | Proportions, Bruxvoort et al.;34 | ||
| Good: completes 5–6 doses | 74.7% | 1† | coefficients, assumption |
| Okay: completes 4 doses | 10.9% | 0.75† | |
| Bad: completes 3 doses | 7.3% | 0.5† | |
| Very bad: completes 2 doses | 3.1% | 0.25† | |
| Does not adhere: completes 0–1 dose | 3.9% | 0† | |
| Patient costs for care-seeking | |||
| Public, private (urban) | $0.73 | 0.18‡ | Rashed et al.37 |
| Public, private (rural) | $0.57 | 0.14‡ | |
| Pharmacy, drug store | $0.37 | 0.09‡ | |
| Pharmacy, drug store (rural) | $0.28 | 0.07‡ | |
| Miscellaneous cost when receiving treatment (e.g., special foods in hospital) | $1.00 | 0.25‡ | Hansen et al.38 |
| Cost of supplemental medicines | $1.00 | 0.25‡ | Batwala et al.39 |
| Average testing cost, private | $1.79 | 0.20 | ACTwatch Group15 |
| Average testing cost, public | $0.00 | – | |
| Additional cost for care-seeking, private | $0.79 | 0.20 | Jimoh et al.,40 Salawu et al.41 |
| Cost of hospitalization | $1.17 | – | Rashed et al.37 |
| Productivity loss per sick day | $2.55 | – | World Bank21 |
| Productivity losses from death | $23,281.21 | – | |
| Neurological sequelae disability productivity losses | $9,731.74 | – | World Bank,21 Dundorp et al.36 |
| Neurological sequelae disability productivity losses (addition for severe cases) | $3,015.91 | – | |
| Patient drug costs | |||
| Public facilities | ACTwatch Group15 | ||
| Average cost of ACTs | $0.00 | – | |
| Average cost of quinine | $0.00 | – | |
| Private facilities | |||
| Average cost of ACTs | $1.82 | ($1.36–$3.41) | |
| Average cost of CQ | $0.42 | ($0.41–$1.06) | |
| Average cost of quinine | $4.30 | ($3.58–$5.37) | |
| Pharmacies | |||
| Average cost of ACTs | $4.97 | ($3.97–$6.56) | |
| Average cost of CQ, “Assumption same as private” | $0.42 | ($0.41–$1.06) | |
| Average cost of quinine | $19.31 | ($5.89–$26.06) | |
| Drug stores | |||
| Average cost of ACTs | $1.36 | ($1.02–$1.70) | |
| Average cost of CQ | $0.41 | ($0.41–$0.42) | |
| Average cost of quinine | $3.58 | ($2.86–$4.30) | |
| Self-treatment | Assumption | ||
| Average cost of ACTs | $0.00 | – | |
| Average cost of CQ | $0.00 | – | |
| Average cost of Quinine | $0.00 | – | |
| Public facility costs | |||
| Cost per test | $1.27 | $0.29 | Uzochukwu et al.,42 Onwujekwe et al.43 |
| Cost of supplemental drugs (antibiotics, analgesics, etc.) | $1.90 | $0.36 | Management Sciences for Health,44 WHO35 |
| Cost per ACT | $1.28 | $0.05 | |
| Cost per CQ | $0.05 | $0.01 | |
| Cost per quinine | $0.05 | $0.03 | |
| Cost per case (without testing or drugs) | $2.96 | $2.19 | WHO45 |
| Cost per pediatric malaria hospitalization | $69.30 | $31.70 | |
| Stockout probabilities of any ACT | |||
| Public facilities | 5.0% | – | ACTwatch Group15 |
| Private facilities | 52.5% | – | |
| Pharmacies | 0.0% | – | |
| Drug stores | 61.5% | – | |
| Self-treatment | 0.0% | – | Assumption |
ACT = artemisinin-based combination therapy; API = active pharmaceutical ingredient; Coeff = coefficient; CQ = chloroquine; SD = standard deviation; SF = substandard or falsified; WHO = World Health Organization.
*
Assumed SD of 20%.
†
Coefficient in model.
‡
Assumed SD of 25%.