ACTing Fast: Exploring Strategic Timing of TACT deployment in Uganda

Abstract

Malaria efficacy in Uganda is threatened by the emerging resistance to artemisinin and its partner drug. Triple artemisinin combination therapy (TACT) is a promising alternative to prevent the rise of resistance. However, uncertainty around resistance trajectories and TACT prices has prevented its implementation. This study examines the cost-effective timing of TACT deployment using a scenario-based cost-effectiveness analysis and real options theory (ROT). The methodology includes a Markov model simulating resistance progression in the national population under three resistance scenarios used by the WHO. The results show that TACT is cost-effective in all scenarios and in some also cost-saving. The findings suggest that adhering to the WHO guideline in all scenarios resulted in a cost-effective deployment. In addition, the findings suggest that the timing of deployment has a limited effect on cost-effectiveness. Rather, the interaction of different scenario characteristics together influences cost-effectiveness. The findings of the study contribute to the literature on management by combining scenario planning and ROT in a practical way. In addition, this study extends the versatility of ROT by combining it with healthcare metrics. In practice, the findings help policymakers explore and prepare for multiple futures, thereby improving flexibility in responding to evolving resistance.