Pharmacoeconomic Evaluation of Artemisinin-Based Combination Therapy Versus Conventional Antimalarials in Pediatric Malaria Management in Kogi State, North Central Nigeria

Artemisinin-based combination therapies have become the standard of care for uncomplicated malaria globally, yet their higher acquisition cost relative to older antimalarials raises questions of economic feasibility in resource-limited settings. This study conducted a pharmacoeconomic evaluation comparing artemisinin-based combination therapy with conventional antimalarials in the management of pediatric uncomplicated malaria in Kogi State, North Central Nigeria. A decision-tree cost-effectiveness analysis was conducted from both the health system and societal perspectives. Clinical effectiveness data were sourced from a retrospective analysis of 600 pediatric malaria cases from four general hospitals over 24 months. Cost data included drug acquisition, administration, monitoring, treatment failure management, and caregiver indirect costs. Effectiveness was expressed as proportion achieving parasitological clearance by day three. Artemisinin-based combination therapy demonstrated a clearance rate of 94 percent compared to 72 percent for conventional antimalarials. The incremental cost-effectiveness ratio of artemisinin-based combination therapy was calculated at 4,800 naira per additional successful treatment, falling below the conventional cost-effectiveness threshold of one times the state per-capita gross domestic product. Sensitivity analysis confirmed robustness of the findings. These results support the economic as well as clinical case for sustained artemisinin-based combination therapy use in pediatric malaria management in Kogi State. The study advocates for government subsidy programs to ensure equitable access in the lowest income communities. Keywords: pharmacoeconomics, artemisinin-based combination therapy, pediatric malaria, cost-effectiveness, Kogi State